Nursing Elites

1. A patient with a history of asthma is admitted with shortness of breath. What is the nurse's priority intervention?

• A. Administer a bronchodilator as prescribed.
• B. Encourage the patient to use an incentive spirometer.
• C. Place the patient in a high Fowler's position.
• D. Monitor the patient's oxygen saturation closely.

Correct answer: A

Rationale: The correct answer is to administer a bronchodilator as prescribed. This intervention is the priority for a patient with asthma experiencing shortness of breath as it helps relax the airways, making breathing easier. Encouraging the use of an incentive spirometer (Choice B) is beneficial for lung expansion but not the priority in this acute situation. Placing the patient in a high Fowler's position (Choice C) can also help with breathing but is not as immediate as administering a bronchodilator. While monitoring the patient's oxygen saturation closely (Choice D) is important, the immediate action to address the breathing difficulty is administering a bronchodilator.

2. A nurse is caring for a client who has an indwelling urinary catheter and a prescription for a urine specimen for culture and sensitivity. Which of the following actions should the nurse take?

• A. Wipe the area around the needleless port with sterile water
• B. Insert the syringe into the needleless port at a 60-degree angle
• C. Withdraw 3 to 5 ml of urine from the port
• D. Don sterile gloves

Correct answer: C

Rationale: The correct action for the nurse to take is to withdraw 3 to 5 ml of urine from the port for an accurate culture and sensitivity test. Wiping the area around the needleless port with sterile water (Choice A) is not necessary when obtaining a urine specimen. Inserting the syringe into the needleless port at a 60-degree angle (Choice B) is incorrect as it does not align with the correct procedure for obtaining a urine specimen. Donning sterile gloves (Choice D) is a good practice but not the immediate action required for obtaining a urine specimen.

3. A family was referred to crisis intervention services after a natural disaster. One family member refuses to attend, stating, 'No way, I'm not crazy.' What is the nurse's best response?

• A. Don't worry now. The psychiatrists are well trained to help.
• B. Many times, disasters can create mental health problems, so you really should participate with your family.
• C. This will help your family communicate better.
• D. Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique.

Correct answer: D

Rationale: The nurse should reassure the family member that seeking help does not imply mental illness, but is part of coping with the disaster.

4. A nurse is providing discharge instructions to a client who has a new prescription for codeine for cough suppression. What is the priority instruction?

• A. Avoid driving
• B. Drink plenty of fluids
• C. Move slowly when standing up
• D. Take with food

Correct answer: C

Rationale: The correct answer is to instruct the client to 'Move slowly when standing up.' Codeine can cause orthostatic hypotension, a drop in blood pressure when changing positions, leading to dizziness or fainting. By advising the client to move slowly when standing up, the nurse helps prevent falls or injuries due to sudden drops in blood pressure. Choices A, B, and D are important instructions as well but not the priority when considering the risk of orthostatic hypotension associated with codeine.

5. A patient is receiving enteral feedings through a nasogastric (NG) tube. What is the most appropriate nursing intervention?

• A. Flush the NG tube with water before and after each feeding.
• B. Check the placement of the NG tube before each feeding.
• C. Administer medications through the NG tube every 4 hours.
• D. Increase the feeding rate if the patient is tolerating well.

Correct answer: B

Rationale: Checking the placement of the NG tube before each feeding is crucial as it ensures the tube is correctly positioned, reducing the risk of complications such as aspiration or improper delivery of feedings. Flushing the NG tube with water before and after each feeding can disrupt the feeding schedule and is not a standard procedure. Administering medications through the NG tube every 4 hours may not be necessary for all patients and should be based on specific medication requirements. Increasing the feeding rate without proper assessment and monitoring can lead to feeding intolerance or complications, making it an inappropriate intervention.

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