Nursing Elites

1. The nurse is caring for a client who is 2 days post-op following an abdominal hysterectomy. The client reports feeling something 'give way' in the incision site and there is a small amount of bowel protruding from the wound. What action should the nurse take first?

• A. Apply a sterile saline dressing to the wound
• B. Notify the healthcare provider
• C. Administer pain medication
• D. Cover the wound with an abdominal binder

Correct answer: A

Rationale: In this situation, the priority action for the nurse is to apply a sterile saline dressing to the wound. This helps to cover and protect the exposed bowel, preventing infection and maintaining a moist environment for wound healing. Option B, notifying the healthcare provider, is important but should come after addressing the immediate need of covering the wound. Administering pain medication (option C) and covering the wound with an abdominal binder (option D) are not appropriate initial actions for this situation.

2. A nurse is planning care for a client in the late stage of amyotrophic lateral sclerosis (ALS). Which nursing diagnosis has the highest priority?

• A. Impaired physical mobility
• B. Ineffective breathing pattern
• C. Impaired skin integrity
• D. Risk for infection

Correct answer: B

Rationale: Ineffective breathing pattern is the highest priority for a client in the late stage of ALS due to the significant risk of respiratory complications. As ALS progresses, the client may experience respiratory muscle weakness, leading to ineffective breathing patterns and potential respiratory failure. Addressing breathing difficulties promptly is crucial to ensure adequate oxygenation and prevent further complications. While impaired physical mobility, impaired skin integrity, and risk for infection are also important concerns in ALS care, they are secondary to addressing the client's breathing difficulties, which take precedence to maintain physiological stability and prevent life-threatening consequences.

3. The healthcare provider prescribes amoxicillin (Amoxil) 1.5 grams PO daily, in equally divided doses to be administered every 8 hours. The medication is available in a bottle labeled Amoxicillin (Amoxil) suspension 200 mg/5 ml. How many ml should the nurse administer every 8 hours?

• A. 10 ml
• B. 12.5 ml
• C. 15 ml
• D. 17.5 ml

Correct answer: B

Rationale: To calculate the correct dosage, first, determine the total daily dose: 1.5 grams = 1500 mg. Since the medication is 200 mg/5 ml, for 1500 mg, the nurse needs to administer 1500/200 = 7.5 times the 5 ml dose. Therefore, 7.5 x 5 ml = 37.5 ml total daily dose. To administer this every 8 hours, divide 37.5 ml by 3 (8 hours intervals in a day) to get 12.5 ml to be administered every 8 hours. Choice A, C, and D are incorrect as they do not reflect the correct calculation of the dose based on the prescription and the available concentration.

4. A client newly diagnosed with gastroesophageal reflux disease (GERD) is being taught about dietary management by a nurse. Which instruction should the nurse include?

• A. Avoid drinking milk
• B. Eat three large meals a day
• C. Avoid eating spicy foods
• D. Increase fluid intake with meals

Correct answer: C

Rationale: The correct instruction for a client with GERD is to avoid eating spicy foods. Spicy foods can exacerbate GERD symptoms by irritating the esophagus and increasing stomach acid production. Avoiding spicy foods can help reduce discomfort and prevent further irritation. Choices A, B, and D are incorrect. Drinking milk is not advised for GERD as it can trigger acid production. Eating three large meals a day can put pressure on the stomach, worsening symptoms. Increasing fluid intake with meals can lead to bloating and worsen GERD symptoms by causing the stomach to expand, pushing more acid into the esophagus.

5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 liters per minute via nasal cannula. The client becomes lethargic and confused. What action should the nurse take first?

• A. Decrease the oxygen flow rate
• B. Increase the oxygen flow rate
• C. Encourage the client to cough and deep breathe
• D. Monitor the client's oxygen saturation level

Correct answer: A

Rationale: In this scenario, the priority action for the nurse is to decrease the oxygen flow rate. Clients with COPD are sensitive to high levels of oxygen and can develop oxygen toxicity, leading to symptoms like lethargy and confusion. Decreasing the oxygen flow rate helps prevent this complication. Increasing the oxygen flow rate would worsen the client's condition. Encouraging coughing and deep breathing may not address the immediate issue of oxygen toxicity. While monitoring the client's oxygen saturation level is important, taking action to address the oxygen toxicity by decreasing the flow rate is the priority in this situation.

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