Nursing Elites

1. The nurse is providing care for a client with chronic obstructive pulmonary disease (COPD). Which intervention is most appropriate to include in the care plan?

• A. Instruct the client to use pursed-lip breathing
• B. Recommend a high-fat, low-carbohydrate diet
• C. Limit physical activity to prevent shortness of breath
• D. Encourage the client to drink large amounts of fluids

Correct answer: A

Rationale: The correct answer is A: Instruct the client to use pursed-lip breathing. Pursed-lip breathing helps improve ventilation and reduce shortness of breath in COPD clients. This technique involves inhaling slowly through the nose and exhaling through pursed lips. Choice B is incorrect because a high-fat, low-carbohydrate diet is not recommended for individuals with COPD as it can lead to weight gain and worsen respiratory function. Choice C is incorrect as limiting physical activity can lead to deconditioning and worsen COPD symptoms. Regular, moderate exercise is beneficial for individuals with COPD. Choice D is incorrect as excessive fluid intake can strain the heart in COPD clients. It is important to maintain adequate but not excessive fluid intake to prevent dehydration and maintain optimal lung function.

2. A client with chronic alcoholism is admitted with a decreased serum magnesium level. Which snack option should the nurse recommend to this client?

• A. Cheddar cheese and crackers
• B. Carrot and celery sticks
• C. Beef bologna sausage slices
• D. Dry roasted almonds

Correct answer: D

Rationale: Dry roasted almonds are the most suitable snack option for a client with chronic alcoholism and a decreased serum magnesium level because they are high in magnesium. Magnesium is essential in addressing the deficiency. Cheddar cheese and crackers (Choice A) do not contain as much magnesium as almonds. Carrot and celery sticks (Choice B) are healthy choices but do not provide a significant amount of magnesium. Beef bologna sausage slices (Choice C) are not a good choice as processed meats are not rich in magnesium.

3. An older adult resident of a long-term care facility has a 5-year history of hypertension. The client has a headache and rates the pain 5 on a pain scale of 0 to 10. The client’s blood pressure is currently 142/89. Which interventions should the nurse implement? (Select all that apply)

• A. Administer the scheduled daily dose of lisinopril.
• B. Assess the client for postural hypotension.
• C. Notify the healthcare provider immediately.
• D. Provide a PRN dose of acetaminophen for the headache.

Correct answer: A

Rationale: In this scenario, the client's blood pressure of 142/89 is within an acceptable range for someone with a history of hypertension. The client's headache with a pain rating of 5 does not warrant an immediate notification to the healthcare provider. Administering the scheduled dose of lisinopril is appropriate to manage the client's hypertension. Assessing the client for postural hypotension is relevant due to the client's age and hypertension history. Providing a PRN dose of acetaminophen for the headache is not necessary at this point as the pain level is moderate and can be managed with other interventions.

4. The charge nurse is making assignments for clients on an endocrine unit. Which client is best to assign to a new graduate nurse?

• A. A female adult with hyperthyroidism who is returning to the unit after a thyroidectomy
• B. A male adult with Cushing's syndrome who reports a headache and visual disturbances
• C. An older man with Addison's disease who is diaphoretic and has hand tremors
• D. A perimenopausal woman with Graves' disease who is nervous and has exophthalmos

Correct answer: A

Rationale: A new graduate nurse can manage the care of a stable client returning from a thyroidectomy. Choice B is not suitable for a new graduate nurse as it involves complex symptoms of Cushing's syndrome that require more experience and knowledge. Choice C presents a client with acute manifestations of Addison's disease, which may be challenging for a new graduate nurse. Choice D involves a client with Graves' disease experiencing nervousness and exophthalmos, which also require a higher level of expertise to manage effectively.

5. Which medication should the nurse anticipate administering to a client who is diagnosed with myxedema coma?

• A. Intravenous administration of thyroid hormones
• B. Oral administration of hypnotic agents
• C. Intravenous bolus of hydrocortisone
• D. Subcutaneous administration of vitamin K

Correct answer: A

Rationale: The correct answer is A: Intravenous administration of thyroid hormones. Myxedema coma is a severe form of hypothyroidism that necessitates immediate replacement of thyroid hormones. Administering thyroid hormones intravenously ensures rapid absorption and effectiveness in managing the condition. Choice B, oral administration of hypnotic agents, is incorrect as it does not address the primary issue of thyroid hormone deficiency in myxedema coma. Choice C, intravenous bolus of hydrocortisone, is not the appropriate treatment for myxedema coma as adrenal insufficiency is not the primary concern in this condition. Choice D, subcutaneous administration of vitamin K, is unrelated to the management of myxedema coma and does not address the underlying thyroid hormone deficiency that characterizes this condition.

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