Nursing Elites

1. A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6�F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first?

• A. Codeine
• B. Guaifenesin (Robitussin)
• C. Acetaminophen (Tylenol)
• D. Piperacillin/tazobactam (Zosyn)

Correct answer: D

Rationale: The correct answer is Piperacillin/tazobactam (Zosyn). Early initiation of antibiotic therapy is crucial in cases of community-acquired pneumococcal pneumonia to reduce mortality. While providing symptomatic relief with medications like Codeine for cough, Guaifenesin for mucus clearance, and Acetaminophen for fever and pain is important, the priority should be to start antibiotic therapy to target the underlying infection. Piperacillin/tazobactam is an appropriate choice for treating severe community-acquired pneumonia caused by pneumococcal organisms.

2. A nurse and client are discussing the client's progress toward understanding his behavior under stress. This is typical of which phase in the therapeutic relationship?

• A. Pre-interaction
• B. Orientation
• C. Working
• D. Termination

Correct answer: C

Rationale: The correct answer is the working phase. During this phase, the nurse and client actively work together to explore alternative behaviors and techniques. Discussions in this phase focus on understanding the underlying meaning behind the behavior and implementing strategies for change. Pre-interaction (choice A) refers to the phase before the nurse and client first meet and establish a relationship. The orientation phase (choice B) involves introductions, setting goals, and establishing boundaries. Termination (choice D) is the phase where the therapeutic relationship concludes, and closure is achieved.

3. The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider?

• A. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97%
• B. pH 7.35, PaO2 85 mm Hg, PaCO2 45 mm Hg, and O2 sat 95%
• C. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98%
• D. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

Correct answer: D

Rationale: The correct answer is D: pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%. These ABG results indicate uncompensated respiratory acidosis, a critical condition that requires immediate attention. In respiratory acidosis, there is an excess of carbon dioxide in the blood, leading to a decrease in pH. The other options present normal or near-normal ABG values, indicating adequate oxygenation and ventilation. Therefore, these values would not be as urgent to report compared to the patient with respiratory acidosis in option D.

4. Which of the following techniques can help to prevent skin irritation or breakdown around a tracheostomy site?

• A. Manage secretions by providing suction on a regular basis
• B. Cleanse the site daily with a mixture of povidone-iodine and water
• C. Avoid using tube ties to secure the tube
• D. None of the above

Correct answer: A

Rationale: Excess secretions from the tracheostomy tube can collect near the stomal opening and cause skin breakdown. Management of secretions through regular suctioning will keep the area clean and dry, minimizing skin irritation. Choice B, cleansing the site daily with povidone-iodine and water, is incorrect as it may lead to skin irritation due to the harshness of povidone-iodine. Choice C, avoiding tube ties to secure the tube, is also incorrect as securing the tube is essential for stability. Choice D, 'None of the above,' is incorrect as managing secretions through suctioning is crucial in preventing skin irritation.

5. What should the nurse in the emergency department do first for a new patient who is vomiting blood?

• A. Insert a large-gauge IV catheter.
• B. Draw blood for coagulation studies.
• C. Check blood pressure (BP), heart rate, and respirations.
• D. Place the patient in the supine position.

Correct answer: C

Rationale: The nurse's initial action should focus on assessing the patient's hemodynamic status by checking vital signs like blood pressure, heart rate, and respirations. This assessment will help determine the patient's immediate needs and guide further interventions. Drawing blood for coagulation studies and inserting an IV catheter are important steps, but they can follow the initial assessment of vital signs. Placing the patient in the supine position can be risky without first assessing the patient's vital signs, as aspiration is a concern. Therefore, assessing vital signs is the priority to ensure appropriate and timely care for the patient.

Similar Questions