Nursing Elites

1. The LPN/LVN is reinforcing instructions to a client on the use of a metered-dose inhaler. The nurse should recognize that the client is using the inhaler correctly if the client takes which action?

• A. Takes a deep breath and then exhales just before administration
• B. Holds the mouthpiece 1 to 2 inches from the mouth
• C. Inhales the medication and then exhales immediately after administration
• D. Performs 3 short inhalations and then exhales deeply after administration

Correct answer: A

Rationale: When using a metered-dose inhaler, the client should take a deep breath and then exhale just before administration. This technique helps ensure that the medication is inhaled effectively. By exhaling before administration, the client can fully inhale the medication into the lungs, maximizing its therapeutic effects. Choice B is incorrect because holding the mouthpiece 1 to 2 inches from the mouth is not a crucial step for using a metered-dose inhaler correctly. Choice C is incorrect because inhaling the medication and then exhaling immediately after administration would not allow the medication to be adequately absorbed into the lungs. Choice D is incorrect because performing 3 short inhalations and then exhaling deeply after administration is not the correct technique for using a metered-dose inhaler.

2. The healthcare provider is reinforcing instructions to a client with heart failure who is prescribed a low-sodium diet. The provider should advise the client to choose which food item?

• A. Canned soup
• B. Fresh vegetables
• C. Processed cheese
• D. Pickled vegetables

Correct answer: B

Rationale: Fresh vegetables are a suitable choice for clients on a low-sodium diet as they are naturally low in sodium and provide essential nutrients. In contrast, canned soup, processed cheese, and pickled vegetables tend to be high in sodium, which is not recommended for individuals with heart failure and on a low-sodium diet. Fresh vegetables are also rich in fiber, vitamins, and minerals, making them a healthier option compared to the other choices provided.

3. The nurse is preparing to care for a client who will be arriving from the recovery room after an above-the-knee amputation. The nurse ensures that which priority item is available for emergency use?

• A. Surgical tourniquet
• B. Dry sterile dressings
• C. Incentive spirometer
• D. Over-the-bed trapeze

Correct answer: A

Rationale: In the case of an above-the-knee amputation, the priority item that should be available for emergency use is a surgical tourniquet. This is crucial to control severe bleeding that may occur post-operatively. Dry sterile dressings (choice B) are important for wound care but not for immediate post-operative emergencies like bleeding. An incentive spirometer (choice C) is used for respiratory exercises and not directly related to emergency management post-amputation. An over-the-bed trapeze (choice D) is used for assisting clients with mobility and positioning, not for emergency situations involving bleeding.

4. The client is receiving heparin therapy for deep vein thrombosis (DVT). Which lab test should be monitored to evaluate the effectiveness of heparin?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Fibrinogen levels

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the appropriate lab test to monitor the therapeutic effectiveness of heparin therapy. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure the client is within the therapeutic range to prevent clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor warfarin therapy, a different anticoagulant that affects the extrinsic pathway of the coagulation cascade. Fibrinogen levels are not specific to monitoring heparin therapy.

5. What predisposing factor most likely contributed to the proximal end of the femur fracture in a 62-year-old woman who lives alone and tripped on a rug in her home?

• A. Failing eyesight leading to an unsafe environment
• B. Renal osteodystrophy from chronic kidney disease (CKD)
• C. Osteoporosis from declining hormone levels
• D. Cerebral vessel changes causing transient ischemic attacks

Correct answer: C

Rationale: The most likely predisposing factor contributing to the proximal end of the femur fracture in a 62-year-old woman is osteoporosis resulting from declining hormone levels. Osteoporosis weakens the bones, making them more susceptible to fractures, especially in older adults, particularly women. In this case, the fracture can be attributed to the bone density loss associated with osteoporosis, which is a common concern in postmenopausal women. Choices A, B, and D are less likely to have directly contributed to the femur fracture in this scenario. Failing eyesight may increase the risk of falls but does not directly weaken the bones. Renal osteodystrophy affects bone health but is less common in this age group. Cerebral vessel changes causing transient ischemic attacks are related to vascular issues, not bone strength.

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