Nursing Elites

1. A 78-year-old client with diabetes is being taught how to care for his feet. Which statement by the client indicates a need for further education?

• A. I will soak my feet in warm water every day.
• B. I will use a mirror to check my feet every day.
• C. I will apply lotion to my feet every day, avoiding the area between the toes.
• D. I will wear properly fitting shoes at all times.

Correct answer: A

Rationale: The correct answer is A. Soaking feet daily can lead to excessive moisture, which can increase the risk of skin breakdown or infection in diabetic clients. Choices B, C, and D are all correct statements for foot care in diabetic clients. Using a mirror for daily foot checks helps in early detection of any issues, applying lotion while avoiding the area between the toes helps keep the skin moisturized without creating a risk for fungal infections, and wearing properly fitting shoes is important to prevent pressure points and potential injuries.

2. A nurse is reviewing the medication list for a client with heart failure. Which medication should the nurse question?

• A. Furosemide
• B. Digoxin
• C. Ibuprofen
• D. Carvedilol

Correct answer: C

Rationale: The correct answer is C: Ibuprofen. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can cause fluid retention, which may worsen heart failure symptoms. It should be used with caution or avoided in clients with heart failure. Furosemide (choice A) is a diuretic commonly used in heart failure to reduce fluid overload. Digoxin (choice B) is a medication that helps the heart beat stronger and slower, often used in heart failure. Carvedilol (choice D) is a beta-blocker that is beneficial in heart failure management. Therefore, Ibuprofen is the medication that the nurse should question in this scenario.

3. An older adult client is admitted with pneumonia and prescribed penicillin G potassium. Which factor increases the risk of an adverse reaction?

• A. Sputum culture showing Streptococcus pneumoniae.
• B. Previous treatment with penicillin.
• C. Daily use of spironolactone for hypertension.
• D. Documented allergy to sulfa drugs.

Correct answer: C

Rationale: The correct answer is C. Daily use of spironolactone for hypertension can increase the risk of hyperkalemia and interact with penicillin, leading to adverse reactions. Choice A is incorrect because the sputum culture showing Streptococcus pneumoniae is an expected finding in a patient with pneumonia and does not increase the risk of an adverse reaction to penicillin. Choice B is incorrect as previous treatment with penicillin does not necessarily increase the risk of an adverse reaction to penicillin if there was no history of allergic reactions. Choice D is also incorrect as a documented allergy to sulfa drugs does not directly increase the risk of an adverse reaction to penicillin.

4. The nurse is teaching a client with asthma to use a peak expiratory flow rate (PEFR) meter to manage asthma at home. The nurse knows the client understands the proper use of the meter when the client:

• A. Inhales as rapidly as possible when using the meter
• B. Records the highest of three readings
• C. Uses the meter after taking a bronchodilator
• D. Blows out forcefully into the meter after taking a deep breath

Correct answer: B

Rationale: The correct answer is B: 'Records the highest of three readings.' When using a peak expiratory flow rate (PEFR) meter, the client should record the highest of three readings to ensure an accurate measurement of their peak expiratory flow rate. Inhaling rapidly, using the meter after taking a bronchodilator, or blowing out forcefully into the meter after a deep breath are not correct techniques for using a PEFR meter and may lead to inaccurate results.

5. A client presents to the emergency room with an acute asthma attack. What is the nurse's priority intervention?

• A. Administer bronchodilators as prescribed.
• B. Administer oxygen at 2 liters per nasal cannula.
• C. Perform chest physiotherapy.
• D. Provide emotional support to reduce anxiety.

Correct answer: A

Rationale: The correct answer is to administer bronchodilators as prescribed. During an acute asthma attack, the priority is to open the airways quickly to help the client breathe more easily. Oxygen may be needed but bronchodilators take precedence as they directly target bronchoconstriction. Chest physiotherapy is not indicated in the acute phase of asthma and may exacerbate the condition. While emotional support is important, addressing the airway obstruction takes precedence in this situation.

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