Nursing Elites

1. A client who is receiving mechanical ventilation and has an ideal weight of 60 kg should have the tidal volume set at which of the following?

• A. 300 mL
• B. 480 mL
• C. 800 mL
• D. 950 mL

Correct answer: B

Rationale: Tidal volume is the amount of air delivered with each breath during mechanical ventilation. A common formula used to calculate tidal volume is 6-8 mL/kg of ideal body weight. For a client with an ideal weight of 60 kg, the expected tidal volume would be 60 kg x 6-8 mL/kg = 360-480 mL. Therefore, the most appropriate choice is 480 mL (Option B), which falls within the expected range based on the client's weight.

2. When reviewing the provider's orders, a nurse recognizes that clarification is needed for which of the following medications in a client experiencing an exacerbation of asthma?

• A. Propranolol
• B. Theophylline
• C. Montelukast
• D. Prednisone

Correct answer: A

Rationale: The correct answer is Propranolol. Propranolol is a beta-blocker that can potentially exacerbate asthma symptoms due to its mechanism of action. It can cause bronchoconstriction, which is harmful for a client experiencing an asthma exacerbation. Theophylline, Montelukast, and Prednisone are commonly used in the treatment of asthma exacerbations and would not typically require clarification in this context.

3. When prioritizing client care after receiving change-of-shift report, which of the following clients should the nurse plan to see first?

• A. A client who is scheduled for an abdominal x-ray and is awaiting transport
• B. A client who has a prescription for discharge
• C. A client who received oral pain medication 30 minutes ago
• D. A client who told an assistive personnel he is short of breath

Correct answer: D

Rationale: When a client expresses being short of breath, it may indicate a serious condition requiring immediate attention to ensure adequate oxygenation. This client should be seen first to assess the severity of the situation and initiate appropriate interventions. The other options, such as awaiting transport for an x-ray, having a prescription for discharge, or receiving oral pain medication 30 minutes ago, do not present immediate life-threatening concerns compared to a client experiencing shortness of breath.

4. After auscultating a client's breath sounds, the nurse is providing care. Which finding is correctly matched to the nurse's primary intervention?

• A. Hollow sounds are heard over the trachea. The nurse increases the oxygen flow rate.
• B. Crackles are heard in bases. The nurse encourages the client to cough forcefully.
• C. Wheezes are heard in central areas. The nurse administers an inhaled bronchodilator.
• D. Vesicular sounds are heard over the periphery. The nurse has the client breathe deeply.

Correct answer: C

Rationale: Wheezes are indicative of narrowed airways, and bronchodilators help to open the air passages, making option C the correct match. Wheezes are typically heard in the central or peripheral lung areas and are associated with conditions like asthma or COPD. Inhaled bronchodilators work by dilating the bronchioles, which helps alleviate wheezing and improve airflow. Therefore, administering an inhaled bronchodilator is the appropriate intervention in response to wheezes.

5. A client is experiencing an acute exacerbation of asthma. Which medication should the nurse administer first?

• A. Albuterol (Proventil)
• B. Ipratropium (Atrovent)
• C. Salmeterol (Serevent)
• D. Fluticasone (Flovent)

Correct answer: A

Rationale: During an acute exacerbation of asthma, the priority is to administer a short-acting beta2-agonist like Albuterol (Proventil) first. Albuterol acts quickly to dilate the airways and provide immediate relief of bronchospasm. Ipratropium (Atrovent) is an anticholinergic that can be used as an adjunct therapy. Salmeterol (Serevent) is a long-acting beta2-agonist intended for maintenance therapy, not for acute exacerbations. Fluticasone (Flovent) is a corticosteroid used for long-term asthma control and should not be the initial medication given during an acute exacerbation.

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