Nursing Elites

1. The client is diagnosed with pneumonia. Which intervention is most effective in promoting airway clearance?

• A. Administer bronchodilators as prescribed
• B. Encourage increased fluid intake
• C. Perform chest physiotherapy
• D. Provide humidified oxygen

Correct answer: B

Rationale: Encouraging increased fluid intake is the most effective intervention in promoting airway clearance for a client with pneumonia. Increasing fluid intake helps to thin respiratory secretions, making it easier for the client to clear the airways. Administering bronchodilators may help with bronchospasm but does not directly promote airway clearance. Chest physiotherapy may be beneficial but is not the first-line intervention for promoting airway clearance in pneumonia. Providing humidified oxygen can improve oxygenation but does not directly address airway clearance.

2. A client who is 24 weeks pregnant presents with a complaint of feeling dizzy when lying on her back. What is the best response by the nurse?

• A. Advise the client to lie on her side
• B. Encourage the client to drink more fluids
• C. Suggest the client elevate her legs when lying down
• D. Recommend the client take short walks throughout the day

Correct answer: A

Rationale: The correct answer is to advise the client to lie on her side. Lying on the side can prevent the compression of the vena cava, which can cause dizziness in pregnant women. Encouraging the client to drink more fluids (Choice B) may be beneficial for other conditions but is not the best response for dizziness when lying on her back. Suggesting the client elevate her legs when lying down (Choice C) is not directly related to the issue described by the client. Recommending the client take short walks throughout the day (Choice D) may be helpful for other pregnancy-related symptoms but is not the most appropriate action for dizziness when lying on her back.

3. When taking blood pressure at the brachial artery, the nurse should place the client's arm in which position?

• A. Slightly above the level of the heart
• B. At the level of the heart
• C. At a level of comfort for the client
• D. Below the level of the heart

Correct answer: B

Rationale: When taking blood pressure at the brachial artery, it is crucial to place the client's arm at the level of the heart to ensure accurate measurement. Placing the arm above or below the heart level can lead to incorrect readings. Option A, placing the arm slightly above the heart level, would result in falsely lower blood pressure readings as gravity would assist in a lower value. Option C, placing the arm at a level of comfort for the client, may not align with the standardized technique required for accurate blood pressure assessment. Option D, placing the arm below the level of the heart, would likely yield falsely higher blood pressure readings due to increased hydrostatic pressure pushing the blood against gravity.

4. When teaching a diabetic client about foot care, what information is most important?

• A. Inspect feet daily
• B. Wear cotton socks
• C. Use lukewarm water to wash feet
• D. Cut nails straight across

Correct answer: A

Rationale: Inspecting feet daily is crucial for diabetic clients as it can help prevent complications like infections and ulcers. This practice allows for early detection of any foot issues, enabling timely intervention. While wearing cotton socks (choice B) is beneficial as they absorb moisture and reduce the risk of fungal infections, it is not as critical as daily foot inspection. Using lukewarm water to wash feet (choice C) is important to prevent burns or skin damage in diabetic clients with decreased sensation, but it is not as crucial as daily foot inspection. Cutting nails straight across (choice D) is essential to prevent ingrown nails, but it is not the most important information when educating diabetic clients about foot care.

5. A nurse in a pediatric unit is preparing to administer medication to a child. What should the nurse do to ensure the correct dosage?

• A. Check the child's weight
• B. Verify the medication order with a pharmacist
• C. Consult the child's parents
• D. Double-check the dosage calculations with another nurse

Correct answer: D

Rationale: When administering medication to children, it is crucial to ensure the correct dosage to prevent dosing errors. Double-checking the dosage calculations with another nurse can help verify the accuracy of the prescribed dose, reducing the risk of medication errors. While checking the child's weight (Choice A) is important for dosage calculation, it alone may not ensure the correctness of the dosage. Verifying the medication order with a pharmacist (Choice B) is essential, but it may not directly address the accuracy of dosage calculations. Consulting the child's parents (Choice C) is not a standard practice for verifying medication dosages and should not be solely relied upon for ensuring the correct dosage.

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