Nursing Elites

1. The parents of a 6-year-old recently diagnosed with asthma should be taught that symptoms of an acute episode of asthma are due to which physiological response?

• A. Inflammation of the mucous membrane and bronchospasm
• B. Increased mucus production and airway obstruction
• C. Hyperinflation of the lungs and alveolar collapse
• D. Bronchoconstriction and airway inflammation

Correct answer: D

Rationale: The correct answer is D: Bronchoconstriction and airway inflammation. During an acute asthma episode, bronchoconstriction and airway inflammation occur, leading to difficulty breathing. Choices A, B, and C are incorrect. Inflammation of the mucous membrane and bronchospasm (Choice A) are part of the pathophysiology of asthma but do not fully explain the symptoms during an acute episode. Increased mucus production and airway obstruction (Choice B) are also seen in asthma but are not the primary cause of acute symptoms. Hyperinflation of the lungs and alveolar collapse (Choice C) are not typical features of an acute asthma episode.

2. A 46-year-old male client who had a myocardial infarction 24 hours ago comes to the nurse's station fully dressed and wanting to go home. He tells the nurse that he is feeling much better at this time. Based on this behavior, which nursing problem should the nurse formulate?

• A. Ineffective coping related to denial.
• B. Risk for impaired cardiac function.
• C. Noncompliance related to lack of knowledge.
• D. Anxiety related to hospitalization.

Correct answer: A

Rationale: The correct answer is A: Ineffective coping related to denial. The client's desire to leave the hospital shortly after a myocardial infarction despite the severity of the condition indicates denial and ineffective coping. This behavior could lead to complications as the client may not adequately address his health needs. Choice B, Risk for impaired cardiac function, is not the most appropriate nursing problem in this scenario as the client's behavior is more indicative of psychological coping issues rather than a direct physiological risk at this moment. Choice C, Noncompliance related to lack of knowledge, does not align with the client's behavior of wanting to leave the hospital. Choice D, Anxiety related to hospitalization, may not be the best option as the client's behavior is more suggestive of denial rather than anxiety about being hospitalized.

3. The nurse teaches an adolescent male client how to use a metered dose inhaler. What instruction should the nurse provide?

• A. Secure the mouthpiece under the tongue.
• B. Press down on the device after breathing in fully.
• C. Move the device one to two inches away from the mouth.
• D. Breathe out slowly and deeply while compressing the device.

Correct answer: C

Rationale: The correct instruction for using a metered dose inhaler is to move the device one to two inches away from the mouth. This distance helps ensure effective delivery of the medication directly to the airways. Choice A is incorrect as the mouthpiece should be placed between the lips, not under the tongue. Choice B is incorrect because the device should be pressed down before breathing in, not after. Choice D is wrong because the patient should breathe out fully before using the inhaler, not while compressing the device.

4. A client with a history of alcoholism is admitted with confusion, ataxia, and nystagmus. Which nursing intervention is a priority for this client?

• A. Monitor for signs of alcohol withdrawal.
• B. Administer thiamine as prescribed.
• C. Provide a quiet environment to reduce confusion.
• D. Initiate fall precautions.

Correct answer: B

Rationale: The correct answer is B: Administer thiamine as prescribed. Administering thiamine is crucial in clients with a history of alcoholism to prevent Wernicke's encephalopathy, which is characterized by confusion, ataxia, and nystagmus. Monitoring for signs of alcohol withdrawal (choice A) is important but not the priority. Providing a quiet environment (choice C) and initiating fall precautions (choice D) are important interventions, but administering thiamine takes precedence due to the risk of Wernicke's encephalopathy.

5. A 75-year-old female client is admitted to the orthopedic unit following an open reduction and internal fixation of a hip fracture. On the second postoperative day, the client becomes confused and repeatedly asks the nurse where she is. What information is most important for the nurse to obtain?

• A. History of alcohol use
• B. Current medication list
• C. Baseline cognitive status
• D. Family history of dementia

Correct answer: A

Rationale: The correct answer is A: History of alcohol use. In this scenario, obtaining the history of alcohol use is crucial as it could indicate withdrawal, which might explain the client's confusion. Alcohol withdrawal can lead to symptoms such as confusion, agitation, and disorientation. While knowing the current medication list (choice B) is important for overall patient care, in this case, alcohol withdrawal is a more likely cause of the confusion. Baseline cognitive status (choice C) is valuable for comparison but may not directly explain the sudden confusion. Family history of dementia (choice D) is less relevant in this acute situation compared to the potential immediate impact of alcohol withdrawal.

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