Nursing Elites

1. The client is reinforcing teaching for peripheral artery disease (PAD). Which statement by the client indicates correct understanding?

• A. I will keep my legs elevated on pillows while resting.
• B. I will avoid crossing my legs when sitting.
• C. I will wear tight compression stockings to improve circulation.
• D. I will apply heat to my legs to relieve pain and improve circulation.

Correct answer: B

Rationale: The correct answer is B. Crossing the legs can further impede blood flow in clients with PAD, worsening symptoms. Avoiding leg crossing helps maintain adequate blood flow and reduces the risk of complications associated with peripheral artery disease. Choices A, C, and D are incorrect because elevating the legs, wearing tight compression stockings, and applying heat can exacerbate symptoms in PAD by restricting blood flow or causing potential harm.

2. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds, expecting to hear which breath sounds bilaterally?

• A. Rhonchi
• B. Crackles
• C. Wheezes
• D. Diminished breath sounds

Correct answer: B

Rationale: In this scenario, the client is exhibiting signs of pulmonary edema, which can occur as a complication of myocardial infarction. Crackles are typically heard in cases of pulmonary edema, characterized by fluid accumulation in the lungs. These crackling sounds are heard during inspiration and sometimes expiration and are an indication of fluid-filled alveoli. Therefore, when assessing the client with these symptoms, the nurse would expect to hear crackles bilaterally. Rhonchi, which are coarse rattling respiratory sounds, are typically associated with conditions like bronchitis or pneumonia, not pulmonary edema. Wheezes are high-pitched musical sounds heard in conditions like asthma or COPD, not commonly present in pulmonary edema. Diminished breath sounds suggest decreased airflow or lung consolidation, not typical findings in pulmonary edema.

3. A healthcare professional is reviewing laboratory results for a client with rheumatoid arthritis prescribed methotrexate. Which of the following laboratory results should the healthcare professional report to the provider?

• A. WBC count 1,200/mm³
• B. Hemoglobin 14 g/dL
• C. Platelets 150,000/mm³
• D. Blood glucose 110 mg/dL

Correct answer: A

Rationale: A WBC count of 1,200/mm³ indicates leukopenia, a serious side effect of methotrexate that can lead to increased risk of infections. It is crucial to report this finding promptly to the provider for further evaluation and possible adjustments in the treatment plan. Choices B, C, and D are within normal ranges and do not represent significant concerns related to methotrexate therapy in this context.

4. A nurse is assessing a client who is taking hydrocodone. Which of the following findings should the nurse report to the provider?

• A. Constipation
• B. Sedation
• C. Dry mouth
• D. Respiratory depression

Correct answer: D

Rationale: The correct answer is D: Respiratory depression. Hydrocodone is an opioid medication that can cause respiratory depression, a serious side effect that should be reported immediately to the healthcare provider. Constipation, sedation, and dry mouth are common side effects of hydrocodone but are not as concerning as respiratory depression. Constipation can be managed with lifestyle modifications and medications, sedation may improve with time or dosage adjustments, and dry mouth is a common and usually benign side effect.

5. A client with a history of heart failure is being discharged with a prescription for digoxin (Lanoxin). The nurse should include which instruction in the discharge teaching?

• A. Take your pulse before each dose and hold the medication if your pulse is below 60 beats per minute.
• B. Increase your fluid intake to at least 3 liters per day.
• C. Report any weight loss of more than 2 pounds in a week.
• D. Take the medication with meals to avoid gastrointestinal upset.

Correct answer: A

Rationale: The correct instruction for discharge teaching regarding digoxin (Lanoxin) is to advise the client to take their pulse before each dose and to hold the medication if their pulse is below 60 beats per minute. Digoxin can cause bradycardia, so monitoring the pulse is crucial to prevent potential complications. Choice B is incorrect because excessive fluid intake can lead to fluid overload, worsening heart failure. Choice C is not directly related to digoxin therapy. Choice D is inaccurate as digoxin is usually taken on an empty stomach to facilitate absorption.

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