Nursing Elites

1. Which intervention should the nurse implement to enhance the efficacy of the client's asthma medication therapy?

• A. Administer the albuterol inhaler before other inhaled medications.
• B. Provide oxygen via nasal cannula at 2 liters/minute.
• C. Encourage the client to drink three liters of fluids daily.
• D. Keep the client upright during nebulizer therapy.

Correct answer: A

Rationale: Administering a bronchodilator such as albuterol as the first step is crucial to open the airways, allowing better penetration of subsequent inhaled medications and enhancing their overall efficacy in managing asthma symptoms.

2. A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response?

• A. Administer a Fleet enema as prescribed and remain with the client
• B. Contact the primary care provider promptly and report these signs of perforation
• C. Position the client supine and insert an NG tube
• D. Page the primary provider and report that the client may be obstructed

Correct answer: B

Rationale: In a client with acute diverticulitis experiencing sudden increase in temperature, exquisite abdominal tenderness, and uncharacteristic abdominal rigidity, these signs suggest a possible perforation. The nurse should promptly contact the primary care provider to report these signs, as perforation requires immediate medical attention to prevent further complications.

3. A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client?

• A. Glasgow Coma Scale
• B. Assess pulses, paresthesia, and paralysis distal to the right knee
• C. Assess pulses, paresthesia, and paralysis proximal to the right knee
• D. Optic nerve using an ophthalmoscope

Correct answer: B

Rationale: In this scenario, the nurse should assess pulses, paresthesia, and paralysis distal to the right knee to evaluate for neurovascular compromise. This assessment helps determine the perfusion and sensation of the lower extremity, which is crucial in identifying potential vascular or nerve damage that may be causing the client's symptoms.

4. A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: B

Rationale: The combination of low TSH and high free T4 levels is characteristic of hyperthyroidism, not hypothyroidism. Hyperthyroidism is associated with symptoms such as fatigue, weight loss, and diarrhea, contrasting with the typical presentation of hypothyroidism. Therefore, in this case, the most likely diagnosis is hyperthyroidism.

5. During an admission physical assessment, the nurse is examining a newborn who is small for gestational age (SGA). Which finding should the nurse report immediately to the pediatric healthcare provider?

• A. Heel stick glucose of 65 mg/dL.
• B. Head circumference of 35 cm (14 inches).
• C. Widened, tense, bulging fontanel.
• D. High-pitched shrill cry.

Correct answer: C

Rationale: A widened, tense, bulging fontanel is a critical finding in a newborn as it can indicate increased intracranial pressure. This condition requires immediate attention and intervention to prevent further complications. Monitoring fontanel status is crucial in assessing the newborn's neurological well-being and ensuring early detection of potential issues.

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