Nursing Elites

1. A client admitted with an episode of bleeding esophageal varices is receiving propranolol (Inderal LA). The nurse knows to monitor for?

• A. Hypertension
• B. Hyperkalemia
• C. Bradycardia
• D. Arthralgia

Correct answer: C

Rationale: The correct answer is 'Bradycardia.' Propranolol is a beta-blocking agent used to decrease the heart rate. In the case of bleeding esophageal varices, propranolol is given to reduce the risk of bleeding by keeping the heart rate around 55 beats per minute. Monitoring for bradycardia is essential as the medication's intended effect is to lower the heart rate. Choices A, B, and D are incorrect because propranolol would not typically cause hypertension, hyperkalemia, or arthralgia.

2. A healthcare provider is screening patients for various vaccines. Which of the following vaccines is contraindicated during pregnancy?

• A. Diphtheria
• B. Hepatitis B
• C. Mumps
• D. Tetanus

Correct answer: C

Rationale: The correct answer is Mumps. The Mumps vaccine, along with the Rubella vaccine, is contraindicated during pregnancy due to the theoretical risk of affecting the developing fetus. Diphtheria, Hepatitis B, and Tetanus vaccines are considered safe during pregnancy and are often recommended to protect both the pregnant individual and the developing fetus. Therefore, choices A, B, and D are incorrect.

3. While assessing a patient who has undergone a recent CABG, the nurse notices a mole with irregular edges and a bluish color. What should the nurse do next?

• A. Recommend a dermatological consult to the physician.
• B. Note the location of the mole and contact the physician via telephone.
• C. Note the location of the mole and follow-up with the attending physician through the medical record and a phone call.
• D. Remove the mole with a sharp debridement technique, following approval from the charge nurse.

Correct answer: C

Rationale: In this scenario, the nurse should note the location of the mole and follow up with the attending physician through the medical record and a phone call. This action is appropriate because a mole with irregular edges and a bluish color raises concern for melanoma, a type of skin cancer. Recommending a dermatological consult (Choice A) might delay the evaluation and management of the mole. Contacting the physician via telephone (Choice B) may not provide a documented record of the observation. Removing the mole without proper evaluation (Choice D) could be dangerous and is not within the nurse's scope of practice.

4. Which of the following food selections would need to be removed from a tray for a client recovering from thyroidectomy?

• A. Fresh apple
• B. V8 juice
• C. Mustard greens
• D. Ice cream

Correct answer: A

Rationale: The correct answer is a fresh apple. After a thyroidectomy, it is important to avoid hard and crunchy foods like apples due to the proximity of the esophagus to the surgical site. Apples can be difficult to chew and swallow, posing a risk of injury or discomfort to the patient. V8 juice, mustard greens, and ice cream are softer options that would be more suitable for a client recovering from thyroidectomy.

5. A mother who has never breastfed a child before is having trouble getting the baby to latch on to the breast. The baby has lost 3% of its birth weight within the first 2 days of life. The best statement is:

• A. The baby will eventually take to the breast.
• B. I can prepare a bottle if you want to try that.
• C. A small amount of weight loss in the first few days is normal.
• D. I can arrange for the charge nurse to come and talk to you about breastfeeding.

Correct answer: C

Rationale: The correct answer is 'A small amount of weight loss in the first few days is normal.' It is important to reassure the mother that a small amount of weight loss, such as 5-10% of birth weight, in the first few days of life is considered normal for newborns. This reassurance helps alleviate the mother's concerns. Option A is incorrect because it does not address the concern about weight loss; it focuses more on the baby eventually latching on. Option B is not recommended as the first solution for breastfeeding issues, as introducing a bottle early on may lead to nipple confusion. Option D involves escalating the situation to the charge nurse when it can be addressed by providing appropriate information and support directly, making it less necessary in this scenario where reassurance and education are key.

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