Nursing Elites

1. A client with a history of asthma is prescribed salmeterol (Serevent). Which instruction should the nurse provide?

• A. Use this medication for acute asthma attacks.
• B. Use this medication before using your albuterol inhaler.
• C. Use this medication twice daily for long-term control.
• D. Use this medication as needed for wheezing.

Correct answer: C

Rationale: The correct instruction for a client prescribed salmeterol (Serevent) is to use it twice daily for long-term control. Salmeterol is a long-acting bronchodilator that is not intended for acute asthma attacks or as-needed use for wheezing. Choice A is incorrect because salmeterol is not used for acute asthma attacks. Choice B is incorrect as salmeterol is not meant to replace the albuterol inhaler but rather used for long-term control. Choice D is incorrect because salmeterol should not be used as needed; it is a maintenance medication for asthma.

2. The client has received 250 ml of 0.9% normal saline through the IV line in the last hour. The client is now tachypneic and has a pulse rate of 120 beats/minute, with a pulse volume of +4. In addition to reporting the assessment findings to the healthcare provider, what action should the nurse implement?

• A. Discontinue the IV and apply pressure at the site.
• B. Decrease the saline to a keep-open rate.
• C. Increase the rate of the current IV solution.
• D. Change the IV fluid to 0.45% normal saline at the same rate.

Correct answer: B

Rationale: In this scenario, the client is showing signs of fluid overload with tachypnea and a high pulse rate. Decreasing the saline to a keep-open rate is appropriate to prevent further fluid volume excess. This action allows for IV access to be maintained while reducing the fluid administered, helping to manage the symptoms of fluid overload.

3. The community mental health nurse is planning to visit four clients with schizophrenia today. Which client should the nurse see first?

• A. The mother who took her children from school because aliens were after them.
• B. The young man who has a history of substance abuse and no telephone.
• C. The newly diagnosed client who needs to be evaluated for medication compliance.
• D. The young woman who believes she is to blame for her recent miscarriage.

Correct answer: A

Rationale: The mother who took her children from school due to delusions of aliens poses a significant risk to her children and herself. This situation requires immediate attention to ensure the safety and well-being of all involved. Choice B is concerning due to the history of substance abuse, but the immediate risk to life and safety as in Choice A takes precedence. Choice C, although important, does not present an immediate danger as the delusional belief of aliens. Choice D, while emotionally distressing, does not pose an immediate threat as the situation described in Choice A.

4. A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

• A. Two to three soft bowel movements daily
• B. Significant increase in appetite and food intake
• C. Absence of nausea and vomiting
• D. Absence of blood or mucus in stool

Correct answer: A

Rationale: Lactulose is used in hepatic encephalopathy to reduce blood ammonia levels by promoting bowel movements. The desired outcome of lactulose therapy is typically two to three soft bowel movements daily, which helps in eliminating excess ammonia from the body, thus improving the client's condition.

5. When a client reports being allergic to penicillin, which question should the nurse ask to gather more information?

• A. Are you allergic to any other medications?
• B. How often have you taken penicillin in the past?
• C. Is anyone else in your family allergic to penicillin?
• D. What happens to you when you take penicillin?

Correct answer: D

Rationale: Questioning the client about the specific allergic reaction to penicillin is crucial for assessing the severity and type of allergic response, aiding in determining appropriate treatment and avoiding potential adverse reactions.

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