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. A client admitted with coronary artery disease (CAD) reports dyspnea at rest. What intervention should the nurse prioritize?

• A. Providing a walker to aid in ambulation
• B. Elevating the head of the bed to at least 45 degrees
• C. Performing continuous monitoring of oxygen saturation
• D. Placing an oxygen cannula at the bedside for use if needed

Correct answer: B

Rationale: In a client with coronary artery disease (CAD) experiencing dyspnea at rest, the priority intervention should be to elevate the head of the bed to at least 45 degrees. This position helps reduce the work of breathing, optimizes lung expansion, and can alleviate symptoms of dyspnea by improving oxygenation and ventilation. Providing a walker for ambulation, monitoring oxygen saturation, and having an oxygen cannula at the bedside are important interventions but not the priority when the client is experiencing dyspnea at rest. Elevating the head of the bed is crucial to improve respiratory function and should be prioritized in this situation.

3. A client has a new prescription for enalapril. Which of the following adverse effects should the client be instructed to monitor and report?

• A. Frequent urination
• B. Tremors
• C. Dry mouth
• D. Persistent cough

Correct answer: D

Rationale: The correct answer is D: Persistent cough. Enalapril, an ACE inhibitor, is known to commonly cause a persistent cough as an adverse effect due to its effect on bradykinin levels. Clients should be instructed to monitor for a persistent cough and report it promptly to their healthcare provider for further evaluation and possible medication adjustment. Choices A, B, and C are incorrect as they are not commonly associated with enalapril use and are not typical adverse effects of ACE inhibitors.

4. A client with a diagnosis of angina pectoris is prescribed nitroglycerin. The nurse should teach the client to take the medication in which way?

• A. Take one tablet daily with breakfast
• B. Take one tablet every 5 minutes as needed, up to three times
• C. Take one tablet every hour until pain subsides
• D. Take one tablet only if pain does not subside after 30 minutes

Correct answer: B

Rationale: Nitroglycerin is a rapid-acting medication used to relieve angina pain by dilating blood vessels. The correct administration is to take one tablet every 5 minutes as needed, up to three doses. This dosing regimen helps in managing acute angina episodes effectively. Choice A is incorrect because nitroglycerin is not taken once daily. Choice C is incorrect because waiting for an hour between doses may not provide timely relief during angina attacks. Choice D is incorrect as it suggests waiting for 30 minutes before taking another dose, which could delay symptom relief in acute situations.

5. A client in the emergency department is bleeding profusely from a gunshot wound to the abdomen. In what position should the nurse immediately place the client to promote maintenance of the client's blood pressure above a systolic pressure of 90 mm Hg?

• A. Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow.
• B. Turn the client prone to apply pressure on the abdominal wound to help staunch the bleeding.
• C. Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the wound.
• D. Put the client on the right side to apply pressure to the liver and spleen to stop hemorrhaging.

Correct answer: C

Rationale: In a client with profuse bleeding from a gunshot wound to the abdomen, maintaining the client in a supine position is essential to manage blood pressure. This position helps in reducing diaphragmatic pressure and allows for proper visualization of the wound, aiding in prompt assessment and intervention to control the bleeding and stabilize the client's condition. Placing the client in a 45-degree Trendelenburg position (Choice A) could worsen the bleeding by increasing intrathoracic pressure and venous return, potentially leading to further hemorrhage. Turning the client prone (Choice B) may not be feasible in this situation and can delay essential interventions. Placing the client on the right side (Choice D) does not address the immediate need to manage the bleeding and stabilize the client's condition.

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