Nursing Elites

1. A client with a history of heart failure is admitted with severe dyspnea. Which intervention should the nurse implement first?

• A. Administer oxygen at 2 liters per minute via nasal cannula.
• B. Place the client in a high Fowler's position.
• C. Obtain a 12-lead electrocardiogram (ECG).
• D. Administer intravenous furosemide (Lasix).

Correct answer: B

Rationale: The correct answer is to place the client in a high Fowler's position first. This intervention helps improve breathing and oxygenation in clients with severe dyspnea, including those with heart failure. Elevating the head of the bed reduces the work of breathing and enhances lung expansion. Administering oxygen, obtaining an ECG, and administering furosemide are important interventions in the management of heart failure, but placing the client in a high Fowler's position is the priority to address the immediate need for improved breathing and oxygenation.

2. The nurse is providing discharge teaching to a client with chronic obstructive pulmonary disease (COPD). Which statement by the client indicates a need for further teaching?

• A. I will use my albuterol inhaler before exercising.
• B. I will avoid secondhand smoke.
• C. I will get a flu shot every year.
• D. I will limit my fluid intake to 2 liters per day.

Correct answer: A

Rationale: Using an albuterol inhaler before exercising is appropriate for clients with COPD to prevent exercise-induced bronchospasm.

3. The school nurse is conducting an audit of incident reports for adolescent students. Which finding is the best indication that the Healthy People 2020 objectives are being addressed?

• A. the absenteeism rate has increased greatly over the past two years
• B. during the last year fewer firearms were retrieved on school property
• C. the number of requests for pregnancy testing is higher than last year
• D. decline in the number of students enrolled in school during the year

Correct answer: B

Rationale: The correct answer is B. A decrease in firearms retrieved on school property is a positive indication that the Healthy People 2020 objectives are being addressed. This finding suggests progress in reducing violence and improving safety in schools, which aligns with the goals of promoting overall health and safety among adolescents. Choices A, C, and D do not directly relate to the Healthy People 2020 objectives. Increased absenteeism, higher requests for pregnancy testing, and a decline in student enrollment do not necessarily reflect the specific health and safety goals outlined in Healthy People 2020.

4. The client with liver cirrhosis needs immediate intervention for which abnormal laboratory result?

• A. Prothrombin time (PT) of 14 seconds.
• B. Bilirubin of 1.2 mg/dL.
• C. Albumin of 4 g/dL.
• D. Ammonia level of 80 mcg/dL.

Correct answer: D

Rationale: An elevated ammonia level of 80 mcg/dL indicates hepatic encephalopathy, a serious complication of liver cirrhosis that requires immediate intervention. Ammonia is a neurotoxin that accumulates in the blood due to impaired liver function, leading to cognitive impairment and altered mental status. Monitoring and lowering ammonia levels are crucial in managing hepatic encephalopathy to prevent further neurological deterioration. Prothrombin time, bilirubin, and albumin levels are important parameters in assessing liver function and overall health status in clients with liver cirrhosis, but an elevated ammonia level poses an immediate threat to neurological function and warrants prompt attention.

5. A government office worker is seen in the emergency room after opening an envelope containing a powder-like substance which is being tested for anthrax. Which discharge instruction should the nurse provide the client concerning inhalation anthrax?

• A. return to the emergency room if flu-like symptoms develop within 42 days
• B. notify co-workers to get the anthrax vaccine at the public health department
• C. isolation from friends and family members is recommended for 3 weeks
• D. cleanse all surfaces touched with pre-moistened antibacterial wipes

Correct answer: A

Rationale: The correct answer is to instruct the client to return to the emergency room if flu-like symptoms develop within 42 days. Flu-like symptoms can be an early sign of inhalation anthrax, and prompt medical intervention is crucial. Choice B is incorrect because the focus should be on the affected individual seeking medical attention rather than vaccinating others. Choice C is incorrect as isolation from friends and family members is not a standard recommendation for inhalation anthrax. Choice D is also incorrect as cleansing surfaces is important for infection control but may not be the priority when facing potential exposure to anthrax.

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