Nursing Elites

1. An older adult male is admitted with complications related to chronic obstructive pulmonary disease (COPD). He reports progressive dyspnea that worsens on exertion, and his weakness has increased over the past month. The nurse notes that he has dependent edema in both lower legs. Based on these assessment findings, which dietary instruction should the nurse provide?

• A. Restrict daily fluid intake
• B. Eat meals at the same time daily
• C. Maintain a low-protein diet
• D. Limit the intake of high-calorie foods

Correct answer: A

Rationale: Dependent edema in both lower legs is a sign of fluid overload, which can exacerbate dyspnea in patients with COPD. Restricting daily fluid intake can help reduce the edema and alleviate breathing difficulties. A low-protein diet is not necessary unless there are specific renal concerns. Eating meals at the same time daily or limiting high-calorie foods is not directly associated with addressing fluid overload and dyspnea in COPD patients.

2. A client with eczema is experiencing severe pruritus. Which PRN prescription should the nurse administer?

• A. Topical corticosteroid
• B. Topical scabicide
• C. Topical alcohol rub
• D. Transdermal analgesic

Correct answer: A

Rationale: The correct answer is A: Topical corticosteroid. Topical corticosteroids are commonly used to manage itching in eczema by reducing inflammation and suppressing the immune response. In this case, for severe pruritus in eczema, a topical corticosteroid would be appropriate. Choice B, Topical scabicide, is used to treat scabies, not eczema. Choice C, Topical alcohol rub, is not typically used to manage pruritus in eczema. Choice D, Transdermal analgesic, is more for pain relief and not specifically targeted at managing itching associated with eczema.

3. The healthcare provider prescribes potassium chloride 25 mEq in 500 ml D5W to infuse over 6 hours. The available 20 ml vial of potassium chloride is labeled '10 mEq/5 ml.' How many ml of potassium chloride should the nurse add to the IV fluid?

• A. 12.5
• B. 5
• C. 10
• D. 20

Correct answer: B

Rationale: To prepare 25 mEq of potassium chloride for the infusion, the nurse should add 5 ml of the 10 mEq/5 ml solution. This concentration provides the required amount of potassium chloride without exceeding the needed volume. Choice A would result in 12.5 mEq, which exceeds the prescribed amount. Choices C and D are incorrect as they do not align with the correct calculation based on the vial concentration.

4. The nurse provides discharge teaching to a client who was recently diagnosed with diabetes mellitus (DM). After receiving the instructions, the client expresses understanding about when, how, and why to take his prescribed medications at home. Which intervention is most important for the nurse to implement?

• A. Review the purpose of medications prescribed for the client to take home with him
• B. Provide the client with a printed list of medications and a schedule for administration
• C. Send a list of medications taken while hospitalized to the client’s healthcare provider
• D. Offer to consult with the pharmacist about resources for reduced-price medications

Correct answer: B

Rationale: Providing the client with a printed list of medications and a schedule for administration is crucial to ensure adherence and understanding of the medication regimen at home. This intervention helps the client follow the prescribed treatment plan accurately. Choice A is not as essential since the client already understands when, how, and why to take the medications. Choice C is not a priority at this point as the client needs information for home medication management. Choice D, while helpful, is not the most important intervention compared to providing a clear list and schedule for medication administration.

5. The client with a mechanical valve replacement understands the discharge teaching when the client makes which statement?

• A. ''I will need to take antibiotics before any type of invasive dental work''
• B. ''I will not have to take any more heart medication since I have a new valve''
• C. ''I will need to have this valve replaced in about 10 years''
• D. ''I should notify my healthcare provider if I hear a clicking sound near my heart''

Correct answer: A

Rationale: The correct answer is A. Clients with mechanical valve replacements need to take prophylactic antibiotics before dental procedures to prevent endocarditis. Choice B is incorrect because even with a new valve, heart medications may still be necessary to manage the condition. Choice C is incorrect because mechanical valves typically do not need replacement as frequently as within 10 years. Choice D is incorrect because hearing a clicking sound near the heart could indicate valve malfunction, not just the need to notify the healthcare provider.

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