Nursing Elites

1. When teaching a client with chronic obstructive pulmonary disease who will start using fluticasone via MDI twice daily, which instruction should the nurse include?

• A. Monitor your heart rate before each dose.
• B. Inspect your mouth for lesions daily.
• C. Do not use this medication to relieve an acute attack.
• D. Do not skip the morning dose even if symptom-free.

Correct answer: B

Rationale: It is crucial for clients using inhaled corticosteroids like fluticasone to inspect their mouths daily for signs of oral thrush, a common side effect. Checking the mouth can help identify lesions early, allowing for timely intervention to prevent worsening of the condition. Monitoring heart rate is not specifically required for this medication. Fluticasone is a maintenance medication used to manage COPD, not to relieve acute attacks. Skipping doses, especially in the morning, can lead to inadequate control of COPD symptoms.

2. A client with chronic obstructive pulmonary disease (COPD) is receiving nutrition education. Which nutrition information should the nurse include in this client's teaching? (Select ONE that does not apply)

• A. Avoid drinking fluids just before and during meals.
• B. Rest before meals if you have dyspnea.
• C. Have about six small meals a day.
• D. Eat high-fiber foods to promote gastric emptying.

Correct answer: D

Rationale: The correct answer is D. Avoiding drinking fluids just before and during meals helps prevent bloating in clients with COPD. Resting before meals if experiencing dyspnea can aid in improving breathing during meals. Having approximately six small meals a day can reduce bloating and help with easier digestion. However, consuming high-fiber foods to promote gastric emptying is not advisable for clients with COPD, as fibrous foods can lead to gas production, abdominal bloating, and increased shortness of breath. Clients with COPD should focus on increasing calorie and protein intake to prevent malnourishment. Increasing carbohydrate intake should also be avoided, as it can raise carbon dioxide production and worsen dyspnea.

3. A client with acute respiratory failure (ARF) is being cared for by a nurse. The nurse should monitor the client for which of the following manifestations of this condition?

• A. Severe dyspnea
• B. Nausea
• C. Decreased level of consciousness
• D. Headache

Correct answer: B

Rationale: In acute respiratory failure, the body is not getting enough oxygen, leading to hypoxia. Symptoms of hypoxia include severe dyspnea (A), decreased level of consciousness (C), and headache (D) due to inadequate oxygen supply to the brain. Nausea (B) is not a typical manifestation of acute respiratory failure and is not directly related to the lack of oxygen in the body. Therefore, the nurse should not monitor the client for nausea as a direct consequence of ARF.

4. A client with heart failure expresses feelings of burden and thoughts of death to a nurse. How should the nurse respond?

• A. Would you like to talk more about this?
• B. You are lucky to have such a devoted daughter.
• C. It is normal to feel as though you are a burden.
• D. Would you like to meet with the chaplain?

Correct answer: A

Rationale: Depression can occur in clients with heart failure, especially in older adults. When a client expresses thoughts of being a burden and death, it is crucial for the nurse to address these concerns. Offering to talk more about the client's feelings provides an opportunity for open communication and a deeper understanding of the client's emotions. Open-ended questions like the one in choice A encourage the client to express themselves freely, leading to better assessment and client-centered care. Choices B and C fail to address the client's emotional distress directly, and choice D diverts the focus without addressing the client's immediate concerns.

5. A client was exposed to anthrax. Which of the following antibiotics should the nurse plan to administer?

• A. Ciprofloxacin
• B. Fluconazole
• C. Tobramycin
• D. Vancomycin

Correct answer: A

Rationale: In the case of anthrax exposure, the recommended antibiotic for prophylaxis and treatment is Ciprofloxacin. Ciprofloxacin is effective against the anthrax bacterium, Bacillus anthracis. Fluconazole is an antifungal medication, Tobramycin is an aminoglycoside antibiotic used for bacterial infections, and Vancomycin is a glycopeptide antibiotic primarily used for Gram-positive bacterial infections. Therefore, the correct choice is Ciprofloxacin.

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