Nursing Elites

1. When organizing home visits for the day, which older client should the home health nurse plan to visit first?

• A. A woman who takes naproxen (Naprosyn) and reports a recent onset of dark, tarry stools.
• B. A man who receives weekly injections of epoetin (Procrit) for a low serum iron level.
• C. A man with emphysema who smokes and is complaining of white patches in his mouth.
• D. A frail woman with heart failure who reported a 2-pound weight gain in the last week.

Correct answer: A

Rationale: The correct answer is A. Dark, tarry stools may indicate gastrointestinal bleeding, a potentially life-threatening condition that requires immediate attention. Visiting this client first is crucial for prompt assessment and intervention. Choices B, C, and D do not present immediate life-threatening conditions that require urgent attention compared to the potential emergency indicated by dark, tarry stools.

2. 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.

3. During a home visit, the nurse observed an elderly client with diabetes slip and fall. What action should the nurse take first?

• A. Give the client 4 ounces of orange juice
• B. Call 911 to summon emergency assistance
• C. Check the client for lacerations or fractures
• D. Assess client's blood sugar level

Correct answer: C

Rationale: The correct first action for the nurse to take after an elderly client with diabetes slips and falls is to check the client for lacerations or fractures. This is crucial to assess for any immediate physical injuries that may need immediate attention. Giving orange juice or assessing the blood sugar level may be important later but checking for injuries takes precedence to ensure the client's safety and well-being. Calling 911 should be considered if there are severe injuries or if the client is in distress, but checking for lacerations or fractures is the priority at the moment.

4. After multiple attempts to stop drinking, an adult male is admitted to the medical intensive care unit (MICU) with delirium tremens. He is tachycardic, diaphoretic, restless, and disoriented. Which finding indicates a life-threatening condition?

• A. Widening QRS complexes and flat T waves
• B. Tachycardia and elevated blood pressure
• C. Restlessness and anxiety
• D. Diaphoresis and dehydration

Correct answer: A

Rationale: The correct answer is A: Widening QRS complexes and flat T waves. In the context of an adult male with delirium tremens and symptoms like tachycardia, diaphoresis, restlessness, and disorientation, the presence of widening QRS complexes and flat T waves on an ECG suggests severe electrolyte imbalance, particularly hypokalemia. This severe electrolyte imbalance can lead to life-threatening arrhythmias such as ventricular tachycardia or fibrillation. Tachycardia and elevated blood pressure (choice B) can be expected in delirium tremens but do not directly indicate a life-threatening condition as widening QRS complexes and flat T waves do. Restlessness and anxiety (choice C) are common symptoms of delirium tremens but do not specifically signify a life-threatening condition. Diaphoresis and dehydration (choice D) are also common in delirium tremens but do not directly point towards a life-threatening electrolyte imbalance as widening QRS complexes and flat T waves do.

5. The nurse is caring for a client with a tracheostomy who has thick, tenacious secretions. Which assessment finding is most concerning?

• A. Crepitus around the tracheostomy site
• B. Dry and cracked tracheostomy site
• C. Yellowing of the skin around the tracheostomy site
• D. Mucous plugging of the tracheostomy tube

Correct answer: D

Rationale: Mucous plugging of the tracheostomy tube is the most concerning finding in a client with a tracheostomy and thick secretions. This can lead to airway obstruction, which requires immediate intervention to maintain a patent airway. Crepitus around the tracheostomy site may indicate subcutaneous emphysema but does not pose an immediate threat to the airway. A dry and cracked tracheostomy site may require interventions to promote healing but is not as urgent as mucous plugging. Yellowing of the skin around the tracheostomy site could indicate infection or impaired circulation, which should be addressed but does not pose the same immediate risk as airway obstruction.

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