Nursing Elites

1. The client is being discharged with a prescription for an inhaled glucocorticoid for asthma. Which of the following statements indicates additional education is needed prior to discharge?

• A. "I will hold my breath for 10 seconds after each puff."?
• B. "I will wait five minutes after taking this medication and then gargle water."?
• C. "I will wait at least one minute between each puff."?
• D. "I will take this medication daily even if I am not having symptoms."?

Correct answer: B

Rationale: The correct answer is, 'I will wait five minutes after taking this medication and then gargle water.' After using an inhaled glucocorticoid, it is essential to wait for 5 minutes and then gargle water to remove any residue from the mouth, which can reduce the risk of developing thrush, a fungal infection. Choice A is correct as holding the breath for 10 seconds after each puff helps the medication reach deep into the lungs. Choice C is also correct as waiting at least one minute between puffs ensures proper delivery of the medication. Choice D is incorrect because it is important to take the medication daily as prescribed to control asthma symptoms, even if the person is not experiencing any at that moment.

2. An Rh-negative woman with previous sensitization has delivered an Rh-positive fetus. Which of the following nursing actions should be included in the client's care plan?

• A. emotional support to help the family cope with feelings of guilt about the infant's condition
• B. administration of MICRhoGam to the woman within 72 hours of delivery
• C. administration of Rh-immune globulin to the newborn within 1 hour of delivery
• D. lab analysis of maternal Direct Coombs' test

Correct answer: A

Rationale: In this scenario, the Rh-negative woman has been sensitized, posing a risk to any Rh-positive fetus she delivers. The most appropriate nursing action is to provide emotional support to help the family cope with the infant's condition. This includes addressing potential outcomes like death or neurological damage. Administering MICRhoGam (Choice B) to a sensitized woman is not recommended; it is only given post-abortion or ectopic pregnancy to prevent sensitization. Rh-immune globulin is not administered to the newborn (Choice C) in this case. Analyzing the maternal Direct Coombs' test (Choice D) is unnecessary; instead, an Indirect Coombs' test is used to assess sensitization. Therefore, the correct nursing action is to offer emotional support to the family, acknowledging the challenges they may face.

3. An LPN is taking care of an elderly client who experiences the effects of Sundowner's Syndrome almost every evening. Which of these interventions implemented by the nurse would be the most helpful?

• A. Place a nightlight in the client's room.
• B. Administer the PRN sedative prescribed by the attending physician.
• C. Remind the client that the things and people they are seeing are not real and that they are safe.
• D. Turn on the TV or radio to a station the client enjoys.

Correct answer: A

Rationale: A nightlight will help reorient the client to his or her surroundings in the evening and nighttime hours. It is best not to challenge the reality of a client experiencing Sundowner's Syndrome, and sedatives may make the effects of the syndrome worse. Every effort should be made to keep the client's room calm, quiet, and peaceful, so noise should be kept to a minimum. Reminding the client that what they are experiencing is not real may cause distress and confusion, while turning on the TV or radio may add unnecessary stimulation instead of promoting a soothing environment.

4. During a routine health screening, the nurse should talk to the parents of a 1-year-old child about which of the following?

• A. the potential hazards of accidents
• B. appropriate nutrition now that the child has been weaned from breastfeeding
• C. toilet training
• D. how to prevent accidents in the house

Correct answer: A

Rationale: During a routine health screening for a 1-year-old child, discussing the potential hazards of accidents is crucial. Accidents are the primary source of injury in children and can be life-threatening. Addressing appropriate nutrition now that the child has been weaned from breastfeeding should have already been discussed. Toilet training is important but is typically addressed at a later age as one year is too early for this milestone. While preventing accidents in the house is important, focusing on the potential hazards of accidents in general is more comprehensive and critical for the child's safety.

5. A pregnant client asks how she can prevent getting Group B Strep. What is the LPN's best response?

• A. You cannot prevent getting Group B Strep; you can only treat it.
• B. You should have your partner wear a condom every time you have intercourse.
• C. You should be extra vigilant about hand-washing, especially in the third trimester.
• D. The Group B Strep vaccine is the only proven way to prevent the disease.

Correct answer: A

Rationale: The best response for the LPN to provide to a pregnant client concerned about preventing Group B Strep is that it cannot be prevented, only treated. Group B Strep is a normal flora found in the vagina, rectum, and intestines of about 25% of women and is not a sexually transmitted disease. Testing for Group B Strep is done in each pregnancy, usually around 35-37 weeks. If a woman tests positive, antibiotics are administered during labor to reduce the risk of complications for both the mother and the baby. Choice A is the correct answer as Group B Strep cannot be prevented but only treated. Choice B is incorrect; condom use does not prevent Group B Strep. Choice C is not the best response as hand-washing is important for general hygiene but does not specifically prevent Group B Strep. Choice D is incorrect as there is no vaccine available to prevent Group B Strep.

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