Nursing Elites

1. In a patient with asthma, which of the following is the most important indicator of respiratory function?

• A. Oxygen saturation.
• B. Respiratory rate.
• C. Arterial blood gases.
• D. Peak expiratory flow rate.

Correct answer: D

Rationale: The peak expiratory flow rate is the most important indicator of respiratory function in asthma because it measures how quickly air can be exhaled, reflecting the severity of airflow limitation. Oxygen saturation (Choice A) is important in assessing oxygenation, but it does not directly reflect respiratory function. Respiratory rate (Choice B) can provide information on breathing patterns but does not quantify airflow limitation. Arterial blood gases (Choice C) give information about gas exchange but are not as specific for assessing asthma control and severity as peak expiratory flow rate.

2. The healthcare provider is developing standards of care for a client with gastroesophageal reflux disease and wants to review current evidence for practice. Which one of the following resources will provide the most helpful information?

• A. A review in the Cochrane Library.
• B. A literature search in a database, such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL).
• C. An online nursing textbook.
• D. The policy and procedure manual at the healthcare agency.

Correct answer: A

Rationale: The Cochrane Library provides systematic reviews of primary research in healthcare, making it a reliable resource for evidence-based practice. Choice B, a literature search in a database like CINAHL, may also be useful but does not guarantee the same level of systematic review and reliability as the Cochrane Library. Choice C, an online nursing textbook, may offer information but might not provide the most current or evidence-based practices. Choice D, the policy and procedure manual at the healthcare agency, is unlikely to offer the comprehensive evidence-based information needed for developing standards of care.

3. A client who is postmenopausal and has had two episodes of bacterial urethritis in the last 6 months asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond?

• A. Your immune system becomes less effective as you age.
• B. Low estrogen levels can make the tissue more susceptible to infection.
• C. You should be more careful with your personal hygiene in this area.
• D. It is likely that you have an untreated sexually transmitted disease.

Correct answer: B

Rationale: Low estrogen levels in postmenopausal women decrease moisture and secretions in the perineal area, causing tissue changes that predispose them to infection, including urethritis. This is a common reason for urethritis in postmenopausal women. While immune function does decrease with aging and sexually transmitted diseases can cause urethritis, the most likely reason in this case is the low estrogen levels. Personal hygiene practices are usually not a significant factor in the development of urethritis.

4. A client taking furosemide (Lasix) reports difficulty sleeping. What question is important for the nurse to ask the client?

• A. What dose of medication are you taking?
• B. Are you eating foods rich in potassium?
• C. Have you lost weight recently?
• D. At what time do you take your medication?

Correct answer: D

Rationale: The nurse needs to determine at what time of day the client takes the Lasix. Due to the diuretic effect of Lasix, clients should take the medication in the morning to prevent nocturia, which may be contributing to the sleep difficulties. Asking about the dose of medication (Choice A) is important but addressing the timing of intake is more crucial in this situation. Inquiring about potassium-rich foods (Choice B) is relevant for clients on potassium-sparing diuretics. Weight loss (Choice C) may be relevant for monitoring the client's overall health but is not directly related to the sleep issue in this case.

5. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39°C. What is the nurse’s next action?

• A. Administer the antibiotic as ordered.
• B. Contact the provider to request another culture.
• C. Discuss the need to add a second antibiotic with the provider.
• D. Review the sensitivity results from the patient’s culture.

Correct answer: D

Rationale: In this scenario, the nurse is observing signs of a possible lack of response to the current antibiotic therapy, such as increased erythema, swelling, and persistent high fever. The next appropriate action for the nurse is to review the sensitivity results from the patient’s culture. This step is crucial to determine if the current antibiotic is effective against the causative organism. If the sensitivity results indicate resistance to the current antibiotic, the antibiotic should be discontinued, and the provider should be notified for a change in therapy. Contacting the provider to request another culture is not the immediate priority, as the existing culture results need to be reviewed first. Adding a second antibiotic should only be considered after confirming the sensitivity results, as unnecessary antibiotic use can lead to antimicrobial resistance.

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