Nursing Elites

1. What intervention should the nurse implement for a patient receiving a blood transfusion?

• A. Administer antihistamines to prevent allergic reactions.
• B. Monitor the patient for signs of circulatory overload.
• C. Ensure the blood transfusion is completed within 4 hours.
• D. Check the patient's vital signs every 30 minutes during the transfusion.

Correct answer: B

Rationale: The correct intervention for a patient receiving a blood transfusion is to monitor the patient for signs of circulatory overload. This is crucial to prevent fluid overload, which can lead to serious complications. Administering antihistamines is not a routine intervention during blood transfusions unless the patient shows signs of an allergic reaction. Ensuring the completion of the blood transfusion within a specific time frame is not as critical as monitoring for circulatory overload. Checking vital signs every 30 minutes is essential, but the specific focus should be on monitoring for signs of circulatory overload.

2. What are the nursing considerations when caring for a patient with chronic obstructive pulmonary disease (COPD)?

• A. Encouraging pursed-lip breathing to improve ventilation
• B. Administering bronchodilators and corticosteroids
• C. Monitoring oxygen saturation and ABGs
• D. Teaching the patient how to use an inhaler

Correct answer: A

Rationale: The correct answer is A. Pursed-lip breathing is a nursing consideration for patients with COPD as it helps improve oxygenation and reduces air trapping. While administering bronchodilators and corticosteroids (choice B) is part of the treatment plan, it is typically done by healthcare providers. Monitoring oxygen saturation and arterial blood gases (ABGs) (choice C) is important but not a direct nursing consideration. Teaching the patient how to use an inhaler (choice D) is relevant but not specific to COPD care.

3. A healthcare professional is preparing to admit a client to the PACU who received a competitive neuromuscular blocking agent. Which of the following items should the healthcare professional place at the client's bedside?

• A. Defibrillator machine
• B. Chest tube equipment
• C. Central venous catheter tray
• D. Bag-valve-mask device

Correct answer: D

Rationale: Corrected Rationale: A bag-valve-mask device is necessary in case of respiratory complications that may arise due to the effects of the neuromuscular blocking agent. The competitive nature of the agent can lead to muscle weakness, including respiratory muscles, necessitating immediate respiratory support. Placing a defibrillator machine, chest tube equipment, or central venous catheter tray at the client's bedside would not be the priority in this situation. While these items may be important in specific scenarios, ensuring the availability of a bag-valve-mask device is crucial to address potential airway and breathing issues promptly.

4. A nurse is caring for a client who has diarrhea due to shigella. Which of the following precautions should the nurse take?

• A. Wear gloves only
• B. Wear a mask
• C. Wash hands before and after client care
• D. Use an N95 respirator

Correct answer: C

Rationale: The correct precaution for a nurse caring for a client with shigella-induced diarrhea is to wash hands before and after client care. Shigella is a highly contagious bacterium that spreads through contaminated food, water, or contact with infected individuals. While wearing gloves is important when directly handling bodily fluids, hand hygiene is crucial in preventing the transmission of the infection. Wearing a mask or using an N95 respirator is not necessary for preventing the spread of shigella, as it primarily spreads through the fecal-oral route rather than through respiratory droplets.

5. A client who has a new prescription for ferrous sulfate is being taught by a nurse. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should expect dark tarry stools.
• B. I should expect increased bruising.
• C. I will not get as many infections.
• D. I will expect the color of my urine to be amber.

Correct answer: A

Rationale: The correct answer is A. When taking ferrous sulfate, dark tarry stools can occur as a common side effect due to the iron content in the medication. This is a normal response to the medication and not a cause for concern. Choices B, C, and D are incorrect because increased bruising, reduced infections, and amber-colored urine are not expected side effects of ferrous sulfate.

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