Nursing Elites

1. A nurse is teaching a client with mild persistent asthma who has been prescribed montelukast. Which statement by the nurse is appropriate?

• A. This medication can be used during an acute asthma attack.
• B. This medication should be taken before exercise.
• C. You can take this medication for 10 days, then discontinue.
• D. This medication helps decrease swelling and mucus production.

Correct answer: D

Rationale: The correct answer is D: 'This medication helps decrease swelling and mucus production.' Montelukast is used for long-term asthma management as it helps reduce inflammation and mucus production in the airways. It is not appropriate for acute asthma attacks. Choice A is incorrect because montelukast is not a rescue medication for acute attacks. Choice B is incorrect because montelukast is not specifically taken before exercise. Choice C is incorrect because montelukast is usually taken regularly, not just for a short duration.

2. A nurse is caring for a client at 32 weeks gestation with a history of cardiac disease. Which position should the nurse recommend to promote optimal cardiac output?

• A. The chest
• B. Standing
• C. Supine
• D. Left lateral

Correct answer: D

Rationale: The left lateral position is the correct choice to promote optimal cardiac output in a pregnant client at 32 weeks gestation with cardiac disease. This position improves venous return and decreases pressure on the vena cava, helping optimize cardiac output. Standing (choice B) would not be recommended as it may decrease venous return. The supine position (choice C) should be avoided in pregnant clients with cardiac disease as it can compress the vena cava, reducing cardiac output and potentially causing hypotension. The chest (choice A) is not a valid position recommendation for optimizing cardiac output in this scenario.

3. A client with a closed head injury has their eyes open when pressure is applied to the nail beds, and they exhibit adduction of the arms with flexion of the elbows and wrists. The client also moans with stimulation. What is the client's Glasgow Coma Score?

• A. 4
• B. 7 (comatose)
• C. 9
• D. 10

Correct answer: B

Rationale: The client's Glasgow Coma Score is 7. This is calculated by assigning 2 points for eye-opening to pain, 2 points for incomprehensible sounds, and 3 points for flexion posturing. Choices A, C, and D are incorrect. Choice A (4) would be the score if the client displayed decerebrate posturing instead of flexion posturing. Choice C (9) would be the score if the client exhibited eye-opening to speech, confused speech, and decorticate posturing. Choice D (10) would be the score if the client showed eye-opening spontaneously, oriented speech, and obeyed commands, which is not the case here.

4. A client newly diagnosed with asthma is receiving discharge instructions from a nurse. Which statement by the client indicates an understanding of the teaching?

• A. I will use my fluticasone inhaler to treat asthma attacks.
• B. I will use a peak flow meter once a week.
• C. I will keep a diary of when I use my albuterol inhaler.
• D. I will limit my fluid intake to prevent mucus production.

Correct answer: C

Rationale: The correct answer is C. Keeping a diary of albuterol use helps monitor the frequency and severity of asthma symptoms, which can guide the healthcare provider in adjusting treatment as needed. Option A is incorrect because fluticasone is a controller medication used for long-term management, not for treating acute asthma attacks. Option B is incorrect as using a peak flow meter once a week may not provide real-time information on asthma control. Option D is incorrect as limiting fluid intake does not directly prevent mucus production in asthma.

5. A nurse observes an assistive personnel (AP) providing care to a child who is in skeletal traction. Which of the following actions requires intervention?

• A. Providing a high-protein snack
• B. Assisting the child to reposition
• C. Placing weights on the child’s bed
• D. Massaging pressure points

Correct answer: C

Rationale: The correct answer is C. Placing weights on the child's bed can alter the traction, which must remain constant to be effective. This action requires immediate intervention to prevent harm. Providing a high-protein snack (Choice A) is appropriate for the child's nutritional needs. Assisting the child to reposition (Choice B) helps prevent complications such as pressure ulcers. Massaging pressure points (Choice D) can help promote circulation and prevent skin breakdown. However, altering the traction by placing weights on the bed can be detrimental to the child's condition and must be corrected promptly.

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