Nursing Elites

1. A client has a new prescription for beclomethasone inhaler to use with an albuterol inhaler for asthma maintenance. What should the nurse instruct the client?

• A. Skip doses if breathing improves
• B. Use the albuterol inhaler first
• C. Gargle with water after each use
• D. Store inhaler in the refrigerator

Correct answer: C

Rationale: The correct answer is to instruct the client to gargle with water after each use of the beclomethasone inhaler. Beclomethasone can cause oral thrush, and gargling with water helps prevent this complication. Choice A is incorrect because the client should not skip doses even if breathing improves, as the medications are prescribed for maintenance. Choice B is incorrect as there is no specific instruction to use the albuterol inhaler first in this scenario. Choice D is incorrect because inhalers should not be stored in the refrigerator unless specified by the manufacturer.

2. A nurse discovers a discrepancy in the narcotics log. What is the appropriate next step?

• A. Correct the log and notify the pharmacy.
• B. Report the discrepancy to the nurse manager.
• C. Re-administer the narcotic.
• D. Dispose of the narcotic and note the discrepancy.

Correct answer: B

Rationale: When a nurse discovers a discrepancy in the narcotics log, the appropriate next step is to report the discrepancy to the nurse manager. This is important to ensure that the issue is properly investigated and addressed. Choice A is incorrect because simply correcting the log and notifying the pharmacy may not address the root cause of the discrepancy. Choice C is incorrect as re-administering the narcotic without clarification could lead to potential harm or legal issues. Choice D is incorrect as disposing of the narcotic without following proper protocols and documentation could result in further complications.

3. A client who reports insomnia is being taught by a nurse about promoting rest and sleep. Which statement should indicate to the nurse that the client understands the instructions?

• A. I will walk briskly for 30 minutes before bedtime
• B. I will have a cup of hot cocoa immediately before bedtime
• C. I will no longer have a glass of wine before bedtime
• D. I will do my muscle relaxation techniques each afternoon

Correct answer: C

Rationale: The correct answer is C because avoiding alcohol before bedtime can help promote better sleep. Choice A is incorrect as vigorous exercise close to bedtime can actually hinder sleep. Choice B is also incorrect as consuming beverages with caffeine or sugar close to bedtime can disrupt sleep. Choice D, while a good practice, does not directly address the issue of avoiding alcohol before bedtime to improve sleep quality.

4. A nurse is caring for a client who has an ethical conflict about the care she is receiving. Which of the following resources should the nurse consult about resolving the dilemma?

• A. Hospital ethics committee
• B. Quality improvement committee
• C. Chaplain
• D. Director of nursing

Correct answer: A

Rationale: The correct answer is the hospital ethics committee. This committee is specifically designed to address and resolve ethical conflicts in patient care. It comprises professionals from various disciplines who can provide guidance and support in navigating ethical dilemmas. Choice B, the quality improvement committee, focuses on enhancing the quality of care provided but may not be equipped to handle ethical conflicts. Choice C, the chaplain, offers spiritual and emotional support but may not have the expertise to resolve ethical dilemmas. Choice D, the director of nursing, is responsible for nursing operations and may not be the appropriate resource for addressing ethical conflicts.

5. A nurse manager of a rural clinic is orienting a new employee. Which of the following information should the nurse include as a characteristic of rural health?

• A. Lower rates of maternal morbidity
• B. Reduced incidence of death from motor-vehicle crashes
• C. Increased rates of chronic illness
• D. More frequent dental preventative care visits

Correct answer: C

Rationale: The correct answer is C: 'Increased rates of chronic illness.' Rural areas often face challenges such as limited access to healthcare services, healthcare provider shortages, socioeconomic factors, and lifestyle choices that contribute to higher rates of chronic illnesses. Maternal morbidity rates are typically higher in rural areas due to limited access to obstetric care. While rural areas may have fewer motor-vehicle crashes compared to urban areas, the severity of crashes is usually higher due to factors like longer emergency response times. Dental care access can also be limited in rural areas, leading to less frequent preventative care visits.

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