Nursing Elites

1. A client with a history of atrial fibrillation is prescribed warfarin. What is the nurse's priority teaching?

• A. Avoid eating foods high in potassium.
• B. Avoid foods high in vitamin K.
• C. Take the medication on an empty stomach.
• D. Take the medication at bedtime for best results.

Correct answer: B

Rationale: The correct answer is B: 'Avoid foods high in vitamin K.' Warfarin is an anticoagulant medication that works by interfering with vitamin K-dependent clotting factors. Therefore, consuming foods high in vitamin K can affect the medication's effectiveness. Choices A, C, and D are incorrect because: A) Warfarin is not affected by foods high in potassium; C) Warfarin should be taken with food to minimize gastrointestinal side effects; D) There is no specific requirement for taking warfarin at bedtime for best results.

2. An older client is admitted to the intensive care unit unconscious after several days of vomiting and diarrhea. The nurse inserts a urinary catheter and observes dark amber urine output. Which intervention should the nurse implement first?

• A. Begin dopamine infusion at 2 mcg/kg/minute.
• B. Begin potassium chloride 10 mEq over 1 hour.
• C. Give a bolus of 0.9% sodium chloride 1000 mL over 30 minutes.
• D. Administer promethazine 25 mg IV push.

Correct answer: C

Rationale: In this scenario, the priority intervention is to give a bolus of 0.9% sodium chloride 1000 mL over 30 minutes. The client's dark amber urine output indicates dehydration and hypovolemia, requiring rapid fluid resuscitation. Dopamine infusion, potassium chloride, and promethazine are not the initial interventions needed for a client with hypovolemic symptoms.

3. A client with asthma is experiencing wheezing. What is the nurse’s priority intervention?

• A. Administer a bronchodilator immediately.
• B. Increase the client's oxygen flow rate.
• C. Perform a chest x-ray to assess lung function.
• D. Place the client in a high Fowler’s position.

Correct answer: A

Rationale: The correct answer is A: Administer a bronchodilator immediately. Wheezing in a client with asthma indicates bronchoconstriction, which can compromise airflow. Administering a bronchodilator is the priority intervention as it helps to open the airways, relieve bronchoconstriction, and improve breathing. Increasing the oxygen flow rate (choice B) may be necessary but is not the priority when the airways are constricted. Performing a chest x-ray (choice C) is not the immediate action needed in this situation. Placing the client in a high Fowler's position (choice D) may provide some relief, but administering a bronchodilator to address the bronchoconstriction is the priority intervention.

4. A client presents to the clinic with a large abscess on the right thigh. The healthcare provider incises and drains the abscess. Which instruction should the nurse provide to the client upon discharge?

• A. Avoid showering until the wound is completely closed
• B. Perform daily wound care and dressing changes
• C. Apply heat to the wound for 15 minutes twice a day
• D. Take the prescribed antibiotic until the wound is fully healed

Correct answer: B

Rationale: After incision and drainage of an abscess, it is crucial to perform daily wound care and dressing changes to prevent infection and promote healing. Avoiding showering until the wound is completely closed (choice A) may not be practical or necessary. Applying heat to the wound (choice C) can increase the risk of infection and delay healing. While taking the prescribed antibiotic (choice D) is important, wound care and dressing changes are more directly related to promoting healing and preventing complications.

5. A client is experiencing angina at rest. Which statement indicates a good understanding of the care required?

• A. I will notify the nurse if my chest pain is not relieved in 30 minutes.
• B. I will use nitroglycerin as needed, every 5 minutes, up to 3 doses.
• C. I will avoid physical activity until the pain subsides completely.
• D. I will take nitroglycerin 30 minutes before any physical activity.

Correct answer: B

Rationale: The correct answer is B. Using nitroglycerin as needed, every 5 minutes, up to 3 doses, is the appropriate management for angina at rest. This helps dilate blood vessels, improving blood flow to the heart. Choice A is incorrect because chest pain that persists at rest should be addressed immediately, not waiting for 30 minutes. Choice C is incorrect as avoiding physical activity is not a recommended approach during an angina episode. Choice D is incorrect because nitroglycerin should be used during chest pain episodes, not as a preventive measure before physical activity.

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