Nursing Elites

1. An obese client with emphysema who smoked at least a pack of cigarettes daily is admitted after experiencing a sudden increase in dyspnea and activity intolerance. Oxygen therapy is initiated, and it is determined that the client will be discharged with oxygen. Which information is most important for the nurse to emphasize in the discharge teaching plan?

• A. Methods for weight loss
• B. Guidelines for oxygen use
• C. Approaches to conserve energy
• D. Strategies for smoking cessation

Correct answer: B

Rationale: In this scenario, the priority for the nurse to emphasize in the discharge teaching plan is the 'Guidelines for oxygen use.' As the client with emphysema is being discharged with oxygen therapy, it is crucial for the nurse to ensure that the client understands how to use oxygen properly to prevent complications and promote effective management of the condition. While weight loss, conserving energy, and smoking cessation are important aspects of care for this client, in this specific case, ensuring the safe and appropriate use of supplemental oxygen takes precedence to optimize the client's respiratory function and overall well-being.

2. A client presents with a fungal urinary tract infection (UTI). Which assessments should the nurse complete? (Select all that apply.)

• A. Palpate the kidneys and bladder.
• B. Assess the medical history and current medical problems.
• C. Perform a bladder scan to assess post-void residual.
• D. Inquire about recent travel to foreign countries.

Correct answer: B

Rationale: When assessing a client with a fungal UTI, the nurse should prioritize gathering information related to the medical history and current medical problems. Clients who are severely immunocompromised or have conditions like diabetes mellitus are more susceptible to fungal UTIs. Assessing the medical history helps identify risk factors and potential causes of the infection. While physical examinations like palpating the kidneys and bladder and performing a bladder scan may be necessary, they should follow the initial assessment of medical history. Inquiring about recent travel to foreign countries is less relevant in the context of a fungal UTI, as the focus should be on immediate medical factors predisposing the client to the infection.

3. The client has been managing angina episodes with nitroglycerin. Which of the following indicates the drug is effective?

• A. Decreased chest pain.
• B. Increased blood pressure.
• C. Decreased blood pressure.
• D. Decreased heart rate.

Correct answer: A

Rationale: The correct answer is A: Decreased chest pain. Nitroglycerin is a vasodilator that works by decreasing myocardial oxygen consumption, which helps to reduce chest pain caused by angina. Therefore, a reduction in chest pain is a positive indicator of the drug's effectiveness. Choices B, C, and D are incorrect because nitroglycerin does not typically increase blood pressure or heart rate; instead, it often causes a decrease in blood pressure due to vasodilation and may cause a reflex tachycardia (increased heart rate) as a compensatory response to lowered blood pressure.

4. An unlicensed assistive personnel (UAP) reports to the nurse that a client with a postoperative wound infection has a temperature of 103°F (39.4°C), blood pressure of 90/70, pulse of 124 beats/minute, and respirations of 28 breaths/minute. When assessing the client, findings include mottled skin appearance and confusion. Which action should the nurse take first?

• A. Transfer the client to the ICU.
• B. Initiate an infusion of intravenous (IV) fluids.
• C. Assess the client's core temperature.
• D. Obtain a wound specimen for culture.

Correct answer: B

Rationale: Initiating an infusion of IV fluids is the priority action to stabilize blood pressure in a client with signs of sepsis. Intravenous fluids help maintain perfusion to vital organs and prevent further deterioration. Option A is not the immediate priority as stabilizing the client's condition can be initiated in the current setting. Option C, assessing the client's core temperature, is important but not the most critical action at this time. Option D, obtaining a wound specimen for culture, is important for identifying the causative organism but is not the first priority in managing a client with signs of sepsis.

5. A client has driven himself to the emergency department. He is 50 years old, has a history of hypertension, and informs the nurse that his father died from a heart attack at age 60. The client has indigestion. The nurse connects him to an electrocardiogram monitor and begins administering oxygen at 2 L/min via nasal cannula. What should the nurse do next?

• A. Call for the physician.
• B. Start an IV infusion.
• C. Obtain a portable chest radiograph.
• D. Draw blood for laboratory studies.

Correct answer: B

Rationale: In a client presenting with possible myocardial infarction who is receiving oxygen therapy and cardiac monitoring, the next priority action is to establish IV access by starting an IV infusion. This allows for prompt administration of medications and fluids as needed in the management of acute coronary syndromes. Calling the physician (Choice A) may be necessary but is not the immediate next step. Obtaining a portable chest radiograph (Choice C) may help in further assessment but is not as crucial as establishing IV access. Drawing blood for laboratory studies (Choice D) is important for diagnostic purposes but is not as urgent compared to starting an IV infusion in the setting of a potential myocardial infarction.

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