Nursing Elites

1. A client is admitted to the hospital with a diagnosis of pneumonia. The client is prescribed intravenous antibiotics and oxygen therapy. Which assessment finding indicates that the client's condition is improving?

• A. Increased white blood cell count
• B. Crackles heard on lung auscultation
• C. Productive cough with green sputum
• D. Decreased respiratory rate from 24 to 18 breaths per minute

Correct answer: D

Rationale: A decrease in respiratory rate indicates that the client's breathing is becoming more stable, which suggests an improvement in their condition. Respiratory rate is a critical indicator of respiratory status and oxygenation. Increased white blood cell count (choice A) suggests ongoing infection, crackles on lung auscultation (choice B) indicate fluid in the lungs, and productive cough with green sputum (choice C) may indicate persistent infection or airway inflammation, which do not necessarily reflect improvement in pneumonia.

2. 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.

3. A client with type 2 diabetes mellitus arrives at the clinic reporting episodes of weakness and palpitations. Which finding should the nurse identify may indicate an emerging situation?

• A. History of hypertension
• B. Fingertips feel numb
• C. Reduced deep tendon reflexes
• D. Elevated fasting blood glucose level

Correct answer: B

Rationale: Numb fingertips may suggest neuropathy, a common complication of diabetes that may indicate a worsening condition. Episodes of weakness and palpitations, combined with neuropathy symptoms, could also suggest hypoglycemia or poor glycemic control, requiring further investigation. The other choices are less likely to be directly related to the client's current symptoms. While a history of hypertension is a common comorbidity in clients with diabetes, it may not directly explain the reported weakness and palpitations. Reduced deep tendon reflexes are more indicative of certain neurological conditions rather than acute emerging situations related to the client's current symptoms. An elevated fasting blood glucose level is expected in a client with type 2 diabetes and may not be the primary indicator of an emerging situation in this context.

4. A client with schizophrenia is experiencing paranoia. What is the nurse's priority intervention?

• A. Reassure the client that their fears are unfounded.
• B. Place the client in a private room to reduce stimuli.
• C. Provide the client with a distraction to redirect their attention.
• D. Encourage the client to express their concerns and validate their feelings.

Correct answer: D

Rationale: Encouraging clients with paranoia to express their concerns and validating their feelings is crucial as it helps establish trust and reduce anxiety. This approach also aids in building a therapeutic relationship. Reassuring the client that their fears are unfounded (Choice A) may invalidate their feelings and worsen trust. Placing the client in a private room to reduce stimuli (Choice B) may be helpful in some situations but does not address the underlying issue of paranoia. Providing a distraction (Choice C) may temporarily shift the client's focus but does not address the root cause of the paranoia. Therefore, the priority intervention is to encourage the client to express their concerns and validate their feelings.

5. A client receiving radiation therapy for breast cancer reports dry, peeling skin at the treatment site. What action should the nurse recommend?

• A. Apply lotion to the treatment area.
• B. Use mild soap and water to cleanse the area.
• C. Cover the area with a sterile dressing.
• D. Allow the skin to air dry after washing.

Correct answer: B

Rationale: The correct recommendation for a client with dry, peeling skin at a radiation therapy treatment site is to use mild soap and water to cleanse the area. This approach helps in preventing skin irritation and reduces the risk of infection. Applying lotion (Choice A) may further irritate the skin due to the chemicals present in the lotion. Covering the area with a sterile dressing (Choice C) is not necessary unless there is an open wound that needs protection. Allowing the skin to air dry after washing (Choice D) may lead to further dryness and peeling.

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