Nursing Elites

1. 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.

2. The healthcare provider prescribes atenolol 50 mg daily for a client with angina pectoris. Which finding should the nurse report to the healthcare provider before administering this medication?

• A. Irregular pulse.
• B. Tachycardia.
• C. Chest pain.
• D. Urinary frequency.

Correct answer: A

Rationale: The correct answer is A: Irregular pulse. An irregular pulse may indicate an arrhythmia, which could be exacerbated by atenolol, a beta-blocker used to treat angina pectoris. Atenolol works by slowing the heart rate, so if the patient already has an irregular pulse, it could worsen with the medication. Tachycardia (choice B) would actually be an expected finding in a patient with angina pectoris, and atenolol is used to help reduce the heart rate in such cases. Chest pain (choice C) is a symptom that atenolol is meant to alleviate, so it would not be a reason to withhold the medication. Urinary frequency (choice D) is not directly related to the administration of atenolol for angina pectoris and would not require immediate reporting to the healthcare provider.

3. The nurse is caring for a client with diabetic ketoacidosis (DKA). Which laboratory value requires immediate intervention?

• A. Serum glucose of 300 mg/dL
• B. Serum potassium of 4.5 mEq/L
• C. Serum bicarbonate of 15 mEq/L
• D. Serum pH of 7.28

Correct answer: D

Rationale: A serum pH of 7.28 indicates metabolic acidosis in a client with diabetic ketoacidosis (DKA), requiring immediate intervention. In DKA, the body produces excess ketones, leading to acidosis. Monitoring and correcting the pH level is crucial in managing DKA. Serum glucose levels may be high in DKA, but the immediate concern is correcting the acidosis to prevent complications. Serum potassium and bicarbonate levels are also important but not as immediately critical as correcting the acidosis in DKA.

4. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which laboratory value is most concerning?

• A. Serum potassium of 5.5 mEq/L
• B. Serum creatinine of 1.5 mg/dl
• C. Serum creatinine of 2.5 mg/dl
• D. White blood cell count of 8,000/mm3

Correct answer: C

Rationale: A serum creatinine level of 2.5 mg/dl is the most concerning laboratory value in a client with chronic kidney disease scheduled for a renal biopsy. An elevated serum creatinine level indicates impaired kidney function, which is critical information before performing a renal biopsy. Option A (Serum potassium of 5.5 mEq/L) may be concerning for hyperkalemia but is not directly related to the renal biopsy procedure. Option B (Serum creatinine of 1.5 mg/dl) is within normal limits, suggesting relatively normal kidney function. Option D (White blood cell count of 8,000/mm3) is within the normal range and not directly related to the renal biopsy procedure or CKD management.

5. At 0600 while admitting a woman for a scheduled repeat cesarean section (C-Section), the client tells the nurse that she drank a cup of coffee at 0400 because she wanted to avoid getting a headache. Which action should the nurse take first?

• A. Ensure preoperative lab results are available
• B. Start prescribed IV with lactated Ringer's
• C. Inform the anesthesia care provider
• D. Contact the client's obstetrician

Correct answer: C

Rationale: The correct action for the nurse to take first is to inform the anesthesia care provider. The patient's ingestion of coffee violates the NPO (nothing by mouth) guidelines before surgery, which increases the risk of aspiration during anesthesia. Informing the anesthesia care provider promptly allows for appropriate assessment and decision-making regarding the patient's anesthesia plan. Ensuring preoperative lab results, starting an IV, or contacting the obstetrician can be important steps but addressing the NPO violation and its implications on anesthesia safety take precedence.

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