Nursing Elites

1. When planning to discharge a client receiving home oxygen therapy, which of the following instructions should the nurse include in the discharge teaching?

• A. Ensure that electrical cords are not frayed
• B. Keep oxygen tanks in a horizontal position
• C. Store extra oxygen tanks in a closed closet
• D. Apply petroleum-based gel to the inside of the nostrils

Correct answer: A

Rationale: The correct answer is to ensure that electrical cords are not frayed. Frayed electrical cords pose a fire hazard when oxygen is in use. Keeping oxygen tanks in a horizontal position (Choice B) is important to prevent leaks but is not the priority compared to fire safety. Storing extra oxygen tanks in a closed closet (Choice C) is also important but not as immediate as preventing fire hazards. Applying petroleum-based gel to the inside of the nostrils (Choice D) is unrelated to oxygen therapy safety and is not recommended.

2. A nurse is caring for a client with a history of substance abuse. Which of the following interventions should the nurse prioritize?

• A. Monitor for withdrawal symptoms
• B. Encourage social activities
• C. Schedule regular follow-ups
• D. Provide educational materials

Correct answer: A

Rationale: The correct answer is to monitor for withdrawal symptoms. This is a priority because individuals with a history of substance abuse are at risk of experiencing withdrawal symptoms when the substance is no longer used. Monitoring for withdrawal symptoms is crucial to ensure the client's safety and to manage any potential complications related to substance withdrawal. Encouraging social activities, scheduling regular follow-ups, and providing educational materials are also important aspects of care, but they are not as critical as monitoring for withdrawal symptoms in this immediate scenario.

3. A nurse is developing discharge care plans for a client who has osteoporosis. To prevent injury, the nurse should instruct the client to:

• A. Perform weight-bearing exercises
• B. Avoid crossing the legs beyond the midline
• C. Avoid sitting in one position for prolonged periods
• D. Splint the affected area

Correct answer: A

Rationale: The correct answer is A: Perform weight-bearing exercises. Weight-bearing exercises strengthen bones and help prevent fractures, which is crucial for clients with osteoporosis. Choices B, C, and D are incorrect. Avoiding crossing the legs beyond the midline and avoiding sitting in one position for prolonged periods are general recommendations for preventing musculoskeletal issues but are not specific to osteoporosis. Splinting the affected area is not a standard practice for managing osteoporosis and preventing fractures.

4. A client is receiving vancomycin. Which of the following should the nurse monitor?

• A. Blood glucose levels
• B. Serum creatinine
• C. INR levels
• D. Liver function tests

Correct answer: B

Rationale: The correct answer is B: Serum creatinine. Vancomycin is known to be nephrotoxic, meaning it can cause kidney damage. Monitoring serum creatinine levels is essential to assess kidney function and detect any signs of nephrotoxicity. Blood glucose levels (choice A) are not directly affected by vancomycin. INR levels (choice C) are typically monitored for clients on anticoagulants, not vancomycin. Liver function tests (choice D) are not primarily affected by vancomycin use; kidney function is of greater concern.

5. A client just received their first dose of lisinopril. Which of the following is an appropriate nursing intervention?

• A. Place the client on cardiac monitoring
• B. Monitor the client’s oxygen saturation
• C. Provide standby assistance when the client gets out of bed
• D. Encourage foods high in potassium

Correct answer: C

Rationale: The correct answer is to provide standby assistance when the client gets out of bed. Lisinopril can cause hypotension, especially after the first dose, which can lead to dizziness and falls. Standby assistance helps prevent potential injury. Placing the client on cardiac monitoring (choice A) or monitoring oxygen saturation (choice B) are not typically necessary after the first dose of lisinopril unless specific symptoms are present. Encouraging foods high in potassium (choice D) is not directly related to the immediate concern of postural hypotension associated with lisinopril.

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