Nursing Elites

1. During an admission assessment on an HIV positive client diagnosed with Pneumocystis carinii pneumonia (PCP), which symptoms should the nurse carefully observe the client for?

• A. Weight loss exceeding 10 percent of baseline body weight
• B. Altered mental status and tachypnea
• C. Creamy white patches in the oral cavity
• D. Normal ABGs with wet lung sounds in all lung fields

Correct answer: B

Rationale: The correct answer is B: Altered mental status and tachypnea. These symptoms are indicative of PCP and severe HIV progression. Weight loss exceeding 10 percent of baseline body weight (choice A) may be seen in HIV/AIDS but is not specific to PCP. Creamy white patches in the oral cavity (choice C) are characteristic of oral thrush, which is more commonly associated with Candida infections in HIV patients. Normal ABGs with wet lung sounds in all lung fields (choice D) would not be expected with PCP, as it typically presents with hypoxemia and diffuse bilateral infiltrates on chest imaging.

2. To differentiate adventitious lung sounds associated with heart failure from those associated with bacterial pneumonia, what information should the nurse review?

• A. Sputum culture findings
• B. Oxygen saturation level
• C. Amount of coughing
• D. Respiratory rate

Correct answer: A

Rationale: The correct answer is A: Sputum culture findings. Reviewing sputum culture findings can provide valuable information to differentiate between bacterial pneumonia and heart failure, as the type of bacteria present in the sputum can help identify the specific infection. Oxygen saturation level (Choice B) is important for assessing oxygenation status but does not directly help in distinguishing between the two conditions based on lung sounds. The amount of coughing (Choice C) and respiratory rate (Choice D) may offer some clinical insights but are not as specific or diagnostic as sputum culture findings when differentiating between heart failure and bacterial pneumonia.

3. The nurse is assessing a client with left-sided heart failure who reports nocturia and dyspnea. The nurse identifies pulsus alternans and crackles in all lung fields. Which action is best to include in the client’s plan of care?

• A. Begin client education about positive inotropic medications.
• B. Place the client in Trendelenburg position.
• C. Prepare the client for an emergency cardiac catheterization.
• D. Monitor serum Troponin, CK, and CK-MB levels.

Correct answer: A

Rationale: In the scenario described, the client is exhibiting signs of left-sided heart failure, such as dyspnea, nocturia, pulsus alternans, and crackles in all lung fields. Positive inotropic medications are commonly used in the treatment of heart failure to improve cardiac contractility and output. Therefore, beginning client education about positive inotropic medications is the best action to include in the client's plan of care. Choice B is incorrect because placing the client in Trendelenburg position is not indicated in the management of left-sided heart failure. Choice C is incorrect as emergency cardiac catheterization is not typically the initial intervention for left-sided heart failure. Choice D is incorrect as monitoring serum Troponin, CK, and CK-MB levels is more pertinent to assessing for myocardial infarction rather than managing heart failure.

4. When caring for a laboring client whose contractions are occurring every 2 to 3 minutes, the nurse should document that the pump is infusing how many ml/hour? (Enter numeric value only. If rounding is required, round to the nearest whole number. Click on each chart tab for additional information. Please be sure to scroll to the bottom right corner of each tab to view all information contained in the client’s medical record.)

• A. 42
• B. 38
• C. 48
• D. 50

Correct answer: A

Rationale: By calculating the infusion rate based on the given chart information, the correct value is 42 ml/hr. This rate ensures proper fluid administration to the laboring client. Choices B (38), C (48), and D (50) are incorrect as they do not align with the calculated infusion rate needed for the client's condition, as per the chart data provided.

5. A postpartum client who is bottle feeding develops breast engorgement. What is the best recommendation for the nurse to provide this client?

• A. Take a prescribed analgesic and expose breasts to air
• B. Place warm packs on both breasts
• C. Avoid stimulation of the breasts and wear a tight bra
• D. Express a small amount of breast milk by hand

Correct answer: C

Rationale: For a postpartum client who is bottle feeding and develops breast engorgement, the best recommendation is to avoid stimulation of the breasts and wear a tight bra. This helps reduce engorgement by decreasing blood flow to the breasts. Option A is incorrect because exposing the breasts to air can further stimulate them, worsening engorgement. Option B is incorrect as warm packs can increase blood flow and exacerbate engorgement. Option D is incorrect as expressing breast milk can lead to further stimulation and increased engorgement.

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