Nursing Elites

1. The nurse notes that an older adult client has a moist cough that increases in severity during and after meals. Based on this finding, what action should the nurse take?

• A. Encourage the client to perform deep breathing exercises daily.
• B. Offer the client additional clear fluids frequently.
• C. Collect a sputum specimen immediately.
• D. Request a consultation to confirm dysphagia

Correct answer: D

Rationale: The correct answer is D. The moist cough that worsens during and after meals suggests possible dysphagia, a condition related to swallowing difficulties. Requesting a consultation for dysphagia is essential for an accurate diagnosis and appropriate management. Encouraging the client to perform deep breathing exercises (choice A) may not address the underlying issue of dysphagia. Offering additional clear fluids (choice B) may not be appropriate for someone with swallowing difficulties. Collecting a sputum specimen (choice C) is not the priority in this scenario as the focus should be on identifying and managing the swallowing problem.

2. A client receives a prescription for acetylcysteine (Mucomyst) 1.4 grams per nasogastric tube q4 hours. Acetylcysteine is available as a 10% solution (10 grams/100ml). How many ml of the 10% solution should the nurse administer per dose?

• A. 7
• B. 10
• C. 14
• D. 1.4 grams of acetylcysteine is equivalent to 14 ml of a 10% solution.

Correct answer: D

Rationale: To determine the amount of the 10% acetylcysteine solution to administer, convert the 1.4 grams to milligrams (1.4 grams = 1400 mg). Then, as the 10% solution contains 10 grams (10,000 mg) per 100 ml, it means there are 1000 mg of acetylcysteine in every 10 ml of the solution (10,000 mg / 100 ml = 100 mg/ml). Therefore, to administer 1400 mg (1.4 grams) of acetylcysteine, the nurse should give 14 ml of the 10% solution. Choices A, B, and C are incorrect as they do not accurately convert the amount of acetylcysteine to the corresponding volume of the 10% solution.

3. What information should the nurse include in the discharge teaching plan of a client with low back pain who is taking cyclobenzaprine to control muscle spasms?

• A. Take this medication with or without food
• B. Avoid using heat or ice on injured muscles while taking this medication
• C. Use cold and allergy medications only as directed by a healthcare provider
• D. Discontinue all nonsteroidal anti-inflammatory medications

Correct answer: C

Rationale: The correct answer is C: 'Use cold and allergy medications only as directed by a healthcare provider.' It is essential to inform the client not to self-medicate with cold and allergy medications or make changes without consulting a healthcare provider to prevent potential drug interactions or adverse effects. Choice A is incorrect because cyclobenzaprine can be taken with or without food, so there is no specific requirement to take it on an empty stomach. Choice B is incorrect because using heat or ice on injured muscles while taking cyclobenzaprine is generally safe and can help with symptom management. Choice D is also incorrect because discontinuing nonsteroidal anti-inflammatory medications should be done under the guidance of a healthcare provider, but it is not a direct concern related to taking cyclobenzaprine for muscle spasms.

4. Which assessment is most important for the nurse to perform before ambulating a client with a history of syncope?

• A. Pedal pulses
• B. Breath sounds
• C. Oxygen saturation
• D. Blood pressure

Correct answer: D

Rationale: The correct answer is 'D: Blood pressure.' It is crucial to check the client's blood pressure before ambulating them, especially if they have a history of syncope. Monitoring blood pressure helps to prevent falls by ensuring that the client's blood pressure is stable enough to tolerate the activity. Choices A, B, and C are not as critical in this scenario. Checking pedal pulses, breath sounds, or oxygen saturation is important but not as crucial as assessing blood pressure when preparing to ambulate a client with a history of syncope.

5. To manage the client’s constipation, which suggestions should the nurse provide? (Select all that apply)

• A. Decrease laxative use to every other day and use oil retention enemas as needed.
• B. Include oatmeal with stewed prunes for breakfast as often as possible.
• C. Increase fluid intake by keeping a water glass next to the recliner.
• D. Recommend seeking help with regular shopping and meal preparation.

Correct answer: C

Rationale: The correct answer is C. Increasing fluid intake is essential for managing constipation. Adequate hydration helps soften stool and promotes bowel movements. Choices A and B are incorrect as decreasing laxative use without medical advice and suggesting specific foods like oatmeal with stewed prunes may not be suitable for every individual with constipation. Choice D is also incorrect as while seeking help with meal preparation can indirectly aid in managing constipation, the immediate need is to increase fluid intake.

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