Nursing Elites

1. A client with lower extremity weakness is being taught a four-point crutch gait by a nurse. Which of the following instructions should the nurse include in the teaching?

• A. Bear weight on both legs.
• B. Move the crutches and the weak leg in unison.
• C. Advance the crutches and the strong leg simultaneously.
• D. Move the crutches forward, then move one leg at a time.

Correct answer: D

Rationale: The correct technique for a four-point crutch gait involves moving the crutches forward, then moving one leg at a time. This method provides stability and support by alternating movement between the crutches and legs. Choice A is incorrect because bearing weight on both legs simultaneously is not the correct method for a four-point gait. Choice B is incorrect as moving the crutches and weak leg together does not provide the required stability. Choice C is incorrect as advancing the crutches and strong leg together does not promote the alternating movement needed for a four-point gait.

2. A male client being discharged with a prescription for the bronchodilator theophylline tells the nurse that he understands he is to take three doses of the medication each day. Since timed-release capsules are not available at the time of discharge, which dosing schedule should the LPN advise the client to follow?

• A. 9 a.m., 1 p.m., and 5 p.m.
• B. 8 a.m., 4 p.m., and midnight.
• C. Before breakfast, before lunch, and before dinner.
• D. With breakfast, with lunch, and with dinner.

Correct answer: B

Rationale: The correct dosing schedule for the client to follow is to take the medication at 8 a.m., 4 p.m., and midnight. This timing spaces the doses evenly over the waking hours, ensuring consistent therapeutic levels of the medication. Choice A (9 a.m., 1 p.m., and 5 p.m.) does not evenly distribute the doses throughout the day. Choices C (Before breakfast, before lunch, and before dinner) and D (With breakfast, with lunch, and with dinner) do not provide the required frequency of dosing needed for optimal therapeutic effect.

3. The client is being taught how to use a peak flow meter. The nurse explains that this device should be used to:

• A. Determine oxygen saturation
• B. Measure forced expiratory volume
• C. Monitor the atmosphere for the presence of allergens
• D. Provide metered doses for inhaled bronchodilator

Correct answer: B

Rationale: A peak flow meter is used to measure forced expiratory volume, which helps in monitoring asthma. This measurement provides valuable information about how well the client's lungs are functioning and how narrow their airways are. Choice A is incorrect because determining oxygen saturation is typically done using a pulse oximeter. Choice C is incorrect as a peak flow meter is not used to monitor the atmosphere for allergens but rather to assess lung function. Choice D is incorrect as providing metered doses for inhaled bronchodilators is the function of a metered-dose inhaler, not a peak flow meter.

4. While auscultating the anterior chest of a client newly admitted to a medical-surgical unit, a nurse listens to the audio clip of breath sounds through her stethoscope. What type of breath sounds does the nurse hear?

• A. Crackles
• B. Rhonchi
• C. Friction rub
• D. Normal breath sounds

Correct answer: D

Rationale: The correct answer is D: Normal breath sounds. In the scenario described, the nurse hears normal bronchovesicular breath sounds, which are moderate in intensity and resemble blowing as air moves through the larger airways during inspiration and expiration. Crackles (choice A) are typically heard in conditions like heart failure or pneumonia and are not present in this case. Rhonchi (choice B) are low-pitched, continuous sounds often associated with conditions like chronic bronchitis or bronchiectasis. Friction rub (choice C) is a grating sound usually heard in conditions like pleurisy or pericarditis, which is not the case here where normal breath sounds are heard.

5. A client with diabetes mellitus is admitted with a blood glucose level of 600 mg/dL. What is the priority nursing action for the LPN/LVN?

• A. Administer insulin as prescribed.
• B. Administer oral hypoglycemic agents.
• C. Monitor blood glucose levels frequently.
• D. Provide a high-calorie diet.

Correct answer: A

Rationale: The correct answer is to administer insulin as prescribed. When a client with diabetes mellitus presents with a critically high blood glucose level like 600 mg/dL, the priority action is to lower the blood glucose level promptly to prevent complications. Insulin is the appropriate medication to rapidly reduce high blood glucose levels. Administering oral hypoglycemic agents may not act quickly enough in this critical situation. While monitoring blood glucose levels frequently is important, immediate intervention to lower the high blood glucose level takes precedence. Providing a high-calorie diet is contraindicated in this scenario as it would further elevate the blood glucose level.

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