Nursing Elites

1. A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom?

• A. Burning pain on swallowing
• B. Regurgitation of undigested food
• C. Symptoms mimicking a myocardial infarction
• D. Chronic parotid abscesses

Correct answer: B

Rationale: Regurgitation of undigested food is a typical symptom of esophageal diverticulum. This condition forms a pouch in the esophagus that can trap food, leading to regurgitation of undigested food. The other options are not typically associated with esophageal diverticulum.

2. A client with a diagnosis of schizophrenia is being treated with risperidone (Risperdal). Which side effect should the nurse monitor for?

• A. Hypertension
• B. Weight loss
• C. Hyperactivity
• D. Hyperglycemia

Correct answer: D

Rationale: The correct answer is D: Hyperglycemia. Risperidone (Risperdal) can lead to metabolic side effects, such as hyperglycemia, which requires monitoring. Choice A, Hypertension, is incorrect because risperidone is not typically associated with hypertension. Choice B, Weight loss, is less common with risperidone use as it can lead to weight gain. Choice C, Hyperactivity, is not a common side effect of risperidone; instead, it is more known for sedative effects.

3. A client is on a mechanical ventilator. Which client response indicates that the neuromuscular blocker tubocurarine chloride (Tubarine) is effective?

• A. The client's extremities are paralyzed.
• B. The peripheral nerve stimulator causes twitching.
• C. The client clenches fist upon command.
• D. The client's Glasgow Coma Scale score is 14.

Correct answer: A

Rationale: The correct answer is A. Tubocurarine chloride is a neuromuscular blocker that works by causing paralysis of skeletal muscles. Therefore, if the client's extremities are paralyzed, it indicates that the medication is effective in achieving the desired muscle relaxation necessary for mechanical ventilation. Choices B and C are incorrect as they suggest muscle activity, which would not be expected with the administration of a neuromuscular blocker. Choice D is unrelated to the effectiveness of tubocurarine chloride.

4. A patient with gout is prescribed allopurinol. What should the nurse include in the patient teaching?

• A. Take the medication with food.
• B. Increase intake of high-purine foods.
• C. Limit fluid intake to 1 liter per day.
• D. Expect immediate pain relief.

Correct answer: A

Rationale: When educating a patient prescribed allopurinol for gout, the nurse should emphasize taking the medication with food to reduce the risk of gastrointestinal upset. It is important to instruct the patient to maintain adequate hydration by consuming plenty of fluids, preferably water, to help prevent kidney stone formation and facilitate the drug's effectiveness. Allopurinol does not provide immediate pain relief but rather works to lower uric acid levels over time, reducing the frequency of gout attacks. Choices B and C are incorrect as increasing high-purine foods can exacerbate gout symptoms, and limiting fluid intake to 1 liter per day is not recommended for gout patients who should maintain good hydration. Choice D is incorrect because allopurinol does not offer immediate pain relief.

5. A 62-year-old male client with a history of coronary artery disease complains that his heart is 'racing' and he often feels dizzy. His blood pressure is 110/60, and he uses portable oxygen at 2 liters per nasal cannula. Based on the rhythm shown, which prescription should the nurse administer?

• A. Give magnesium via secondary infusion.
• B. Initiate IV heparin solution as per protocol.
• C. Administer IV adenosine (Adenocard).
• D. Prepare for synchronized cardioversion.

Correct answer: C

Rationale: Administering IV adenosine is the appropriate intervention for a client with symptomatic tachycardia to restore normal sinus rhythm. Adenosine is a medication used to treat supraventricular tachycardia (SVT) by interrupting the reentry pathways through the AV node and restoring normal sinus rhythm. It is a rapid-acting medication given as a rapid IV push followed by a saline flush. The dose is typically administered in a healthcare setting where cardiac monitoring is available due to its potential to cause transient asystole.

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