Nursing Elites

1. A client has a new diagnosis of COPD. Which of the following instructions should the nurse include in the teaching?

• A. Breathe rapidly through your mouth when using the incentive spirometer.
• B. Use pursed-lip breathing during periods of dyspnea.
• C. Avoid drinking fluids during meals.
• D. Use diaphragmatic breathing during periods of dyspnea.

Correct answer: B

Rationale: Pursed-lip breathing is a beneficial technique for clients with COPD as it helps control shortness of breath and improves oxygenation. This technique involves inhaling slowly through the nose and exhaling through pursed lips, which helps keep airways open. Option A is incorrect as breathing rapidly through the mouth when using the incentive spirometer can lead to hyperventilation. Option C is incorrect because it is important for clients with COPD to stay hydrated by drinking fluids between meals, but not during meals which can cause bloating and discomfort. Option D is incorrect as diaphragmatic breathing, though beneficial, is not the preferred technique for managing dyspnea in COPD; pursed-lip breathing is more effective.

2. A nurse is caring for a client who has diabetes insipidus. Which of the following findings should the nurse expect?

• A. Weight gain
• B. Increased urine output
• C. Bradycardia
• D. Hyperactive bowel sounds

Correct answer: B

Rationale: Increased urine output is a key finding in clients with diabetes insipidus due to a deficiency of antidiuretic hormone. Weight gain (choice A) is not expected in diabetes insipidus as it is a condition characterized by excessive thirst and urination leading to fluid loss. Bradycardia (choice C) and hyperactive bowel sounds (choice D) are not typically associated with diabetes insipidus.

3. A nurse is caring for a client who has heart failure and is receiving a continuous IV infusion of furosemide. Which of the following findings indicates the nurse should increase the client's infusion rate?

• A. Urine output of 20 mL/hr
• B. Heart rate of 90/min
• C. Sodium level of 138 mEq/L
• D. Weight gain of 1 kg in 24 hr

Correct answer: D

Rationale: A weight gain of 1 kg in 24 hours can indicate fluid retention and worsening heart failure, requiring an increase in diuresis. This finding suggests that the current diuretic therapy is not effective enough to manage the fluid overload, necessitating an increase in the infusion rate of furosemide. Choices A, B, and C are not directly related to the need for an increase in diuretic therapy in heart failure patients. Urine output of 20 mL/hr, a heart rate of 90/min, and a sodium level of 138 mEq/L are important parameters to monitor but do not specifically indicate the need to increase the infusion rate of furosemide.

4. A nurse is caring for a 1-day-old newborn who has jaundice and is receiving phototherapy. Which of the following actions should the nurse take?

• A. Feed the infant 30 ml (1 oz) of glucose water every 2 hours.
• B. Keep the infant's head uncovered.
• C. Ensure that the newborn wears a diaper.
• D. Apply lotion to the newborn every 4 hours.

Correct answer: C

Rationale: The correct action for the nurse to take is to ensure that the newborn wears a diaper. This is important to prevent irritation during phototherapy, as exposure to light can increase the risk of skin breakdown. Feeding the infant glucose water is unnecessary and not indicated for jaundice treatment. Keeping the infant's head uncovered allows the light to reach the skin effectively. Applying lotion to the newborn every 4 hours can interfere with the effectiveness of phototherapy and is not recommended.

5. A client with asthma asks how to use a peak flow meter. Which of the following instructions should the nurse provide?

• A. Use the peak flow meter at the same time each day.
• B. Take a slow, deep breath and blow out as hard as you can.
• C. Keep a log of your peak flow readings.
• D. Perform the test before using any bronchodilators.

Correct answer: D

Rationale: The correct answer is to instruct the client to perform the peak flow test before using any bronchodilators. This is important because it provides the most accurate baseline measurement of lung function. Choice A is not necessarily crucial for the accuracy of the test. Choice B describes the technique for spirometry, not peak flow meter use. Choice C, while important for tracking trends, is not directly related to the accuracy of the initial measurement.

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