Nursing Elites

1. A male client with heart failure presents with shortness of breath, audible wheezing, and pink frothy sputum. What action should the nurse take?

• A. Consult with the charge nurse regarding morphine prescription.
• B. Administer the dose of morphine sulfate as prescribed.
• C. Withhold morphine until dyspnea resolves.
• D. Review the need for the prescription with the healthcare provider.

Correct answer: B

Rationale: The correct answer is B: Administer the dose of morphine sulfate as prescribed. In heart failure, morphine helps reduce anxiety, preload, and afterload on the heart, improving oxygenation. The client's symptoms indicate acute decompensated heart failure, and morphine should be administered promptly to relieve distress. Consulting the charge nurse (Choice A) or withholding morphine (Choice C) would delay necessary treatment. Reviewing the prescription with the healthcare provider (Choice D) is not needed in this acute situation.

2. A scrub nurse preparing for the first surgery of the day asks if a 3-minute surgical hand scrub is adequate. What should the circulating nurse advise?

• A. Proceed with surgery preparation
• B. Extend scrub time to 5 minutes
• C. Use an alcohol-based hand sanitizer
• D. Scrub time depends on the type of surgery

Correct answer: B

Rationale: The circulating nurse should advise the scrub nurse to extend the hand scrub to 5 minutes for thorough preparation, especially for the first surgery of the day. Choice A is incorrect as it does not address the need for a longer scrub time. Choice C is incorrect as alcohol-based hand sanitizer is not a substitute for a thorough surgical hand scrub. Choice D is incorrect as while scrub time may vary based on the surgery, for the first surgery of the day, a longer scrub time is recommended as a standard practice.

3. An adolescent who was diagnosed with diabetes mellitus Type 1 at the age of 9 is admitted to the hospital in diabetic ketoacidosis. Which occurrence is the most likely cause of ketoacidosis?

• A. Had a cold and ear infection for the past two days
• B. Missed a dose of insulin
• C. Did not follow dietary restrictions
• D. Overexerted during exercise

Correct answer: A

Rationale: The correct answer is A. Infections, like a cold and ear infection, increase the body's metabolic needs and insulin resistance, making diabetic ketoacidosis (DKA) more likely. While missing insulin doses or not following dietary restrictions can trigger DKA, an illness is the most common precipitating factor in pediatric Type 1 diabetes. Option B is less likely as missing insulin can lead to hyperglycemia but might not be the immediate cause of ketoacidosis. Option C can contribute to DKA over time, but the acute trigger is usually an illness. Option D, overexertion during exercise, is less likely to cause DKA compared to an infection.

4. The nurse is instructing a 65-year-old female client diagnosed with osteoporosis. The most important instruction regarding exercise would be to

• A. Exercise doing weight-bearing activities
• B. Exercise to reduce weight
• C. Avoid exercise activities that increase the risk of fracture
• D. Exercise to strengthen muscles and thereby protect bones

Correct answer: A

Rationale: Weight-bearing exercises are crucial in managing osteoporosis as they help strengthen bones. Choice A is the correct answer because weight-bearing activities, such as walking, dancing, or weight training, help stimulate bone formation and strengthen bones, which is essential in managing osteoporosis. Choice B is incorrect as the primary focus should be on the type of exercise rather than weight reduction. Choice C is incorrect because avoiding exercise altogether can lead to further bone density loss, and it is important to engage in safe weight-bearing activities. Choice D is incorrect as the primary goal of exercise in osteoporosis is to improve bone density through weight-bearing activities.

5. A client with type 1 diabetes is admitted to the emergency room with abdominal pain, polyuria, and confusion. What should the nurse implement first?

• A. Administer intravenous insulin.
• B. Start an intravenous fluid bolus.
• C. Obtain a blood glucose level.
• D. Administer an antiemetic.

Correct answer: B

Rationale: In this scenario, the nurse should first start an intravenous fluid bolus. This intervention is crucial in addressing severe dehydration associated with diabetic ketoacidosis, a life-threatening complication of type 1 diabetes. Administering intravenous insulin (Choice A) is important but should follow fluid resuscitation. Obtaining a blood glucose level (Choice C) is necessary but not as urgent as addressing the dehydration. Administering an antiemetic (Choice D) is not the priority in this situation.

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