Nursing Elites

1. A nurse is assessing a client who has chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse report to the provider?

• A. Oxygen saturation of 91%
• B. Use of pursed-lip breathing
• C. Productive cough with green sputum
• D. Decreased breath sounds in the right lower lobe

Correct answer: D

Rationale: The correct finding the nurse should report to the provider is decreased breath sounds in the right lower lobe. This can indicate a respiratory infection or atelectasis in clients with COPD, requiring further evaluation and intervention. Choice A, an oxygen saturation of 91%, although slightly lower than normal, does not necessarily require immediate reporting unless the client's baseline is significantly higher. Choice B, the use of pursed-lip breathing, is actually a beneficial technique for clients with COPD to improve oxygenation and reduce shortness of breath, so it does not need reporting. Choice C, a productive cough with green sputum, can be common in clients with COPD and may indicate an infection, but it is not as concerning as decreased breath sounds in a specific lung lobe which may signify a more acute issue.

2. A client with diabetes mellitus is being taught by a nurse on managing hypoglycemia. Which of the following instructions should the nurse include?

• A. Avoid consuming carbohydrate-rich foods.
• B. Consume 15 grams of a fast-acting carbohydrate.
• C. Drink a glass of water to raise blood glucose levels.
• D. Eat a snack before exercising to prevent hypoglycemia.

Correct answer: B

Rationale: The correct answer is B: Consume 15 grams of a fast-acting carbohydrate. Consuming 15 grams of a fast-acting carbohydrate, such as glucose tablets or juice, helps raise blood glucose levels quickly in cases of hypoglycemia. Choice A is incorrect because avoiding carbohydrate-rich foods during hypoglycemia can worsen the condition. Choice C is incorrect as drinking water does not effectively raise blood glucose levels. Choice D is incorrect as eating a snack before exercising is more related to preventing exercise-induced hypoglycemia, not managing hypoglycemia.

3. What is the best intervention for a patient experiencing respiratory distress?

• A. Administer oxygen
• B. Administer bronchodilators
• C. Administer IV fluids
• D. Reposition the patient

Correct answer: A

Rationale: Administering oxygen is the best intervention for a patient experiencing respiratory distress because it helps improve oxygenation. Oxygen therapy is the initial and priority intervention to ensure an adequate oxygen supply to the body tissues. Administering bronchodilators (Choice B) may be appropriate for specific respiratory conditions like asthma or COPD but is not the first-line intervention in all cases of respiratory distress. Administering IV fluids (Choice C) is not a standard intervention for respiratory distress unless there is an underlying cause like dehydration. Repositioning the patient (Choice D) can aid in optimizing ventilation but is not the primary intervention for respiratory distress.

4. A nurse is providing teaching to a client who has a new prescription for warfarin. Which of the following statements indicates a need for further teaching?

• A. I will take warfarin every other day.
• B. I will eat more leafy green vegetables while taking warfarin.
• C. I will use a soft toothbrush while taking warfarin.
• D. I will have my INR checked regularly while taking warfarin.

Correct answer: B

Rationale: The correct answer is B. Eating more leafy green vegetables can increase vitamin K intake, which may reduce the effectiveness of warfarin. This can lead to fluctuations in the International Normalized Ratio (INR) levels, affecting the medication's efficacy. Choices A, C, and D are correct statements. Taking warfarin every other day, using a soft toothbrush to prevent gum bleeding, and having regular INR checks are all appropriate and important actions when taking warfarin.

5. A nurse is assessing a client who has schizophrenia and is taking chlorpromazine. Which of the following findings should the nurse identify as an adverse effect of the medication?

• A. Weight gain
• B. Dry mouth
• C. Sedation
• D. Diarrhea

Correct answer: C

Rationale: The correct answer is C: Sedation. Chlorpromazine, an antipsychotic medication, commonly causes sedation as an adverse effect. Weight gain (choice A) is a potential side effect of some antipsychotic medications, but it is not specifically associated with chlorpromazine. Dry mouth (choice B) is a common anticholinergic side effect of many medications but is not a prominent adverse effect of chlorpromazine. Diarrhea (choice D) is not a typical adverse effect of chlorpromazine.

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