Nursing Elites

1. Oxygen via nasal cannula has been prescribed for a client with emphysema. The nurse checks the physician’s orders to ensure that the prescribed flow is not greater than:

• A. 1 L/min
• B. 3 L/min
• C. 4 L/min
• D. 6 L/min

Correct answer: B

Rationale: The correct answer is B, 3 L/min. Clients with emphysema typically receive oxygen at a flow rate of 1 to 2 L/min, with a maximum of 3 L/min. Higher flow rates can lead to oxygen toxicity in these clients, so it's crucial to adhere to the prescribed limits. Choice A (1 L/min) is too low and may not provide adequate oxygenation for the client. Choices C (4 L/min) and D (6 L/min) exceed the recommended flow rates for clients with emphysema and can increase the risk of oxygen toxicity.

2. When planning care for a client newly diagnosed with open-angle glaucoma, the nurse identifies a priority nursing problem of 'visual sensory/perceptual alterations.' This problem is based on which etiology?

• A. Blurred distance vision
• B. Limited eye movement
• C. Decreased peripheral vision
• D. Photosensitivity

Correct answer: C

Rationale: The correct answer is 'C: Decreased peripheral vision.' Open-angle glaucoma leads to a gradual loss of peripheral vision due to damage to the optic nerve. This loss of peripheral vision is a hallmark sign of the condition and a primary reason for the visual sensory/perceptual alterations experienced by the client. Blurred distance vision (choice A) may occur but is not the priority nursing problem. Limited eye movement (choice B) and photosensitivity (choice D) are not typically associated with the sensory/perceptual alterations seen in open-angle glaucoma.

3. After educating a client with hypertension secondary to renal disease, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching?

• A. I can prevent more damage to my kidneys by managing my blood pressure.
• B. If I have increased urination at night, I need to drink less fluid during the day.
• C. I need to see the registered dietitian to discuss limiting my protein intake.
• D. It is important that I take my antihypertensive medications as directed.

Correct answer: B

Rationale: Choice B is incorrect because the client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and they should be thoroughly assessed for potential dehydration. To decrease increased nocturnal voiding, clients should consume fluids earlier in the day. Choices A, C, and D are correct statements. Managing blood pressure is crucial to slow the progression of renal dysfunction. Limiting protein intake is important in renal disease management, and clients should be referred to a dietitian as needed. Taking antihypertensive medications as directed is essential for blood pressure control.

4. After a client with peripheral vascular disease undergoes a right femoral-popliteal bypass graft, their blood pressure drops from 124/80 to 94/62. What should the nurse assess first?

• A. IV fluid infusion.
• B. Pedal pulses.
• C. Nasal cannula oxygen flow rate.
• D. Capillary refill time.

Correct answer: B

Rationale: Assessing pedal pulses is crucial in this situation as it helps determine the adequacy of perfusion to the lower extremity following a bypass graft. A decrease in blood pressure postoperatively could indicate decreased perfusion, making the assessment of pedal pulses a priority to ensure proper circulation. Checking IV fluid infusion, nasal cannula oxygen flow rate, or capillary refill time are not the immediate priorities in this scenario and would not provide direct information about perfusion to the affected extremity.

5. Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay the development of:

• A. Chronic obstructive pulmonary disease (COPD).
• B. Pancreatic cancer.
• C. Renal failure.
• D. Cerebrovascular accident.

Correct answer: C

Rationale: The correct answer is C: Renal failure. ACE inhibitors are commonly used in clients with diabetes mellitus to help reduce the progression of diabetic nephropathy by improving renal blood flow. This medication class can help prevent or delay the development of renal failure in these clients. Choices A, B, and D are incorrect because ACE inhibitors do not have a direct impact on preventing or delaying the development of chronic obstructive pulmonary disease, pancreatic cancer, or cerebrovascular accidents in clients with diabetes mellitus.

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