Nursing Elites

1. After working with a very demanding client, an unlicensed assistive personnel (UAP) tells the nurse, 'I have had it with that client. I just can't do anything that pleases him. I'm not going in there again.' The nurse should respond by saying

• A. He has a lot of problems. You need to have patience with him.
• B. I will talk with him and try to figure out what to do.
• C. He is scared and taking it out on you. Let's talk to figure out what to do.
• D. Ignore him and get the rest of your work done. Someone else can take care of him for the rest of the day.

Correct answer: C

Rationale: The correct response is to acknowledge the UAP's feelings while exploring the client's behavior. By stating, 'He is scared and taking it out on you. Let's talk to figure out what to do,' the nurse shows empathy and readiness to address the situation collaboratively. This approach helps maintain a therapeutic environment for both the UAP and the client. Choices A and D are dismissive and do not address the underlying issue or provide support. Choice B, while showing willingness to intervene, lacks the understanding of the client's potential fear and does not address the UAP's feelings.

2. A client is receiving a blood transfusion and develops chills and back pain. What is the nurse's first action?

• A. Stop the transfusion and notify the healthcare provider.
• B. Monitor the client's vital signs every 15 minutes.
• C. Administer a PRN dose of diphenhydramine.
• D. Prepare to administer an antihistamine.

Correct answer: A

Rationale: The correct first action for the nurse is to stop the transfusion and notify the healthcare provider. These symptoms suggest a transfusion reaction, and stopping the transfusion is crucial to prevent further complications. Notifying the healthcare provider ensures timely intervention and appropriate management for the client's condition. Monitoring vital signs, administering diphenhydramine, or preparing to administer an antihistamine can be considered after stopping the transfusion and seeking guidance from the healthcare provider. However, the immediate priority is to halt the transfusion and inform the provider.

3. The nurse is caring for a client who has COPD and chest pain related to a recent fall. What nursing intervention requires the greatest caution when caring for a client with COPD?

• A. Administering narcotics for pain relief
• B. Encouraging the client to increase fluid intake
• C. Applying oxygen therapy at a high flow rate
• D. Assisting the client with deep breathing exercises

Correct answer: C

Rationale: The correct answer is C: Applying oxygen therapy at a high flow rate. In clients with COPD, high levels of supplemental oxygen can suppress the hypoxic drive to breathe, leading to carbon dioxide retention and respiratory depression. Oxygen therapy must be administered cautiously to prevent worsening respiratory status. Administering narcotics for pain relief (Choice A) can be necessary but should be done judiciously. Encouraging fluid intake (Choice B) and assisting with deep breathing exercises (Choice D) are generally beneficial interventions for clients with COPD and should not require the same level of caution as high-flow oxygen therapy.

4. A client is admitted with pneumonia and is started on antibiotics. After 3 days, the client reports difficulty breathing and a rash. What is the nurse's first action?

• A. Administer epinephrine
• B. Discontinue the antibiotic
• C. Assess the client's oxygen saturation
• D. Call the healthcare provider

Correct answer: B

Rationale: The client's difficulty breathing and rash suggest a possible allergic reaction to the antibiotic. The first action the nurse should take is to discontinue the antibiotic to prevent further exposure. Administering epinephrine should only be done in severe cases of anaphylaxis, which is not indicated solely by difficulty breathing and rash. While assessing the client's oxygen saturation is important, discontinuing the potential allergen takes precedence. Contacting the healthcare provider should be done after discontinuing the antibiotic and assessing the client to report the situation and seek further guidance.

5. A client with a urinary tract infection is prescribed trimethoprim. What is the most important teaching point?

• A. Take the medication only when symptoms are severe.
• B. Take the medication until symptoms disappear.
• C. Report any pain or burning with urination.
• D. Take the full course of antibiotics, even if symptoms improve.

Correct answer: D

Rationale: The correct answer is D: 'Take the full course of antibiotics, even if symptoms improve.' It is crucial for clients to complete the full course of antibiotics as prescribed to ensure that the infection is fully eradicated and to prevent the development of antibiotic resistance. Choice A is incorrect because antibiotics should not be reserved for severe symptoms only; they should be taken as prescribed. Choice B is incorrect as stopping the medication once symptoms disappear may lead to a relapse of the infection. Choice C is important but not the most crucial teaching point when compared to completing the full course of antibiotics.

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