Nursing Elites

1. A client is prescribed an inhaled corticosteroid for asthma management. Which instruction should the nurse provide to the client regarding the use of this medication?

• A. Rinse your mouth after using the inhaler
• B. Hold your breath for 5 seconds after inhaling the medication
• C. Use the inhaler during an acute asthma attack
• D. Take the medication only when symptoms occur

Correct answer: A

Rationale: The correct instruction for a client using an inhaled corticosteroid for asthma management is to rinse the mouth after using the inhaler. This helps prevent oral thrush, a common side effect of corticosteroid inhalers. Holding the breath for 5 seconds after inhaling the medication (Choice B) is not necessary for corticosteroid inhalers. Using the inhaler during an acute asthma attack (Choice C) is not the purpose of corticosteroids, which are used for long-term asthma management. Taking the medication only when symptoms occur (Choice D) is not correct as corticosteroids are typically used regularly to control asthma symptoms.

2. A client with deep vein thrombosis (DVT) is prescribed warfarin. What lab value should the nurse review before administering the medication?

• A. Prothrombin time (PT)
• B. Hemoglobin and hematocrit (H&H)
• C. International Normalized Ratio (INR)
• D. Partial thromboplastin time (PTT)

Correct answer: C

Rationale: The correct answer is C: International Normalized Ratio (INR). Before administering warfarin to a client with deep vein thrombosis, the nurse should review the INR to ensure the client is within the therapeutic range. INR is specifically monitored for patients on warfarin therapy to assess the clotting ability of the blood. Choices A, B, and D are incorrect as they are not the primary lab value used to monitor warfarin therapy. Prothrombin time (PT) is used to measure how long blood takes to clot. Hemoglobin and hematocrit (H&H) assess for anemia and the blood's oxygen-carrying capacity. Partial thromboplastin time (PTT) is used to monitor heparin therapy, not warfarin.

3. A client with chronic kidney disease is admitted with complaints of fatigue and swelling in the lower extremities. What laboratory finding is most important for the nurse to report?

• A. Serum creatinine level of 2.0 mg/dL.
• B. Hemoglobin level of 8 g/dL.
• C. Potassium level of 5.6 mEq/L.
• D. Blood urea nitrogen (BUN) level of 25 mg/dL.

Correct answer: B

Rationale: The correct answer is B. A hemoglobin level of 8 g/dL suggests anemia, which commonly occurs in clients with chronic kidney disease and requires prompt intervention. Reporting this finding is crucial to address the anemic condition. Choices A, C, and D are important in the context of chronic kidney disease but do not directly relate to the symptoms of fatigue and swelling in the lower extremities described in the scenario.

4. A client presents to the clinic with concerns about her left breast. Which assessment finding is most important for the nurse to report?

• A. Multiple firm, round, freely movable masses.
• B. A slight asymmetry of the breasts.
• C. A fixed nodular mass with dimpling of the skin.
• D. Bloody discharge from the nipple.

Correct answer: C

Rationale: The correct answer is C. A fixed nodular mass with dimpling of the skin is concerning for malignancy, such as breast cancer, and should be reported immediately for further evaluation. This finding is more suspicious compared to multiple firm, round, freely movable masses (choice A), which could be benign breast lumps. A slight asymmetry of the breasts (choice B) is a common finding and not as alarming as a fixed nodular mass with dimpling of the skin. Bloody discharge from the nipple (choice D) can be suggestive of other conditions like intraductal papilloma but is not as urgent as the finding described in choice C.

5. A 60-year-old female client with a positive family history of ovarian cancer has developed an abdominal mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear results are negative. What information should the nurse include in the client’s teaching plan?

• A. Pap smear is sufficient to detect ovarian cancer
• B. Surgery is unnecessary based on negative Pap smear
• C. Further evaluation involving surgery may be needed
• D. No further tests are needed

Correct answer: C

Rationale: A negative Pap smear does not rule out ovarian cancer, which often requires more comprehensive evaluation, including imaging studies or surgery. The client should be informed that the Pap smear primarily detects cervical cancer, not ovarian cancer. Therefore, further evaluation involving imaging studies or surgery may be necessary to determine the presence of ovarian cancer. Choice A is incorrect because a Pap smear is not sufficient to detect ovarian cancer. Choice B is incorrect because surgery may be necessary for further evaluation if ovarian cancer is suspected. Choice D is incorrect because further tests are needed to confirm or rule out ovarian cancer.

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