Nursing Elites

1. What is the best intervention for a patient experiencing respiratory distress?

• A. Administer oxygen
• B. Administer bronchodilators
• C. Administer IV fluids
• D. Reposition the patient

Correct answer: A

Rationale: Administering oxygen is the best intervention for a patient experiencing respiratory distress because it helps improve oxygenation. Oxygen therapy is the initial and priority intervention to ensure an adequate oxygen supply to the body tissues. Administering bronchodilators (Choice B) may be appropriate for specific respiratory conditions like asthma or COPD but is not the first-line intervention in all cases of respiratory distress. Administering IV fluids (Choice C) is not a standard intervention for respiratory distress unless there is an underlying cause like dehydration. Repositioning the patient (Choice D) can aid in optimizing ventilation but is not the primary intervention for respiratory distress.

2. A nurse is providing dietary teaching to a client who has a new diagnosis of chronic kidney disease. Which of the following foods should the nurse instruct the client to avoid?

• A. Baked chicken
• B. Bananas
• C. Lean cuts of beef
• D. Canned soup

Correct answer: D

Rationale: The correct answer is D: Canned soup. Canned soups are typically high in sodium, which can lead to fluid retention in clients with chronic kidney disease. Sodium restriction is crucial in managing this condition. Choice A, baked chicken, is a lean protein source that is generally recommended for individuals with kidney disease. Bananas (Choice B) are high in potassium, so clients with kidney disease may need to limit their intake depending on their individual treatment plan. Lean cuts of beef (Choice C) can be a good source of protein and iron for clients with kidney disease as long as portion sizes are controlled to manage protein intake.

3. What is the appropriate intervention when a patient experiences a fall?

• A. Assess for injuries
• B. Call for help
• C. Document the fall
• D. Notify the healthcare provider

Correct answer: A

Rationale: The appropriate intervention when a patient experiences a fall is to assess for injuries. This immediate action helps in identifying any harm or complications resulting from the fall, allowing for timely intervention. Calling for help may be necessary after assessing the injuries, but the priority is to evaluate the patient's condition. Documenting the fall is important for record-keeping purposes but should come after ensuring the patient's safety. Notifying the healthcare provider can be done once the assessment has been completed and any necessary initial interventions have been initiated.

4. A client receiving chemotherapy is being taught about infection prevention by a nurse. Which of the following instructions should the nurse include?

• A. Wear a mask when gardening.
• B. Avoid crowds to reduce the risk of infection.
• C. You should take a daily vitamin to prevent infection.
• D. Increase your intake of high-protein foods.

Correct answer: B

Rationale: The correct answer is B: 'Avoid crowds to reduce the risk of infection.' Clients receiving chemotherapy are immunocompromised, so avoiding crowds can help decrease the likelihood of exposure to infections. Wearing a mask when gardening (choice A) is important but not directly related to infection prevention in the context of chemotherapy. Taking a daily vitamin (choice C) may be beneficial for overall health but is not specifically focused on infection prevention. Increasing intake of high-protein foods (choice D) is essential for nutrition but does not directly address infection prevention.

5. A nurse is assessing a client who has pericarditis. Which of the following findings is the priority?

• A. Paradoxical pulse
• B. Dependent edema
• C. Pericardial friction rub
• D. Substernal chest pain

Correct answer: A

Rationale: In a client with pericarditis, the priority finding is a paradoxical pulse. This is a crucial sign of cardiac tamponade, a life-threatening complication of pericarditis where fluid accumulates in the pericardial sac, causing compression of the heart. A paradoxical pulse is an exaggerated decrease in systolic blood pressure (>10 mmHg) during inspiration. Prompt recognition and intervention are essential to prevent hemodynamic instability and cardiac arrest. Dependent edema (choice B) is not typically associated with pericarditis. Pericardial friction rub (choice C) is a common finding in pericarditis but does not indicate the urgency of intervention as a paradoxical pulse. Substernal chest pain (choice D) is a classic symptom of pericarditis but is not as critical as a paradoxical pulse in the context of assessing for complications.

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