Nursing Elites

1. What is the priority nursing action for a laboring client dilated to 6 cm receiving an epidural?

• A. Continuous monitoring of maternal blood pressure.
• B. Frequent auscultation of the fetal heart rate.
• C. Administering an IV fluid bolus of at least 500 cc.
• D. Frequent monitoring of the maternal temperature.

Correct answer: A

Rationale: The priority nursing action for a laboring client dilated to 6 cm receiving an epidural is continuous monitoring of maternal blood pressure. This is crucial because epidural anesthesia can lead to a precipitous drop in blood pressure, which can be dangerous for both the mother and fetus by reducing cardiac output and placental perfusion. While frequent auscultation of the fetal heart rate is important, it is not the priority in this situation. Administering an IV fluid bolus of at least 500 cc may not be necessary if the client's blood pressure is stable. Monitoring the maternal temperature is also essential but takes precedence over blood pressure monitoring.

2. One drug can alter the absorption of another drug. One drug increases intestinal motility. Which effect does this have on the second drug?

• A. None; absorption of the second drug is not affected.
• B. The increased gut motility decreases the absorption of the second drug.
• C. The absorption of the second drug cannot be predicted.
• D. Less of the second drug is absorbed.

Correct answer: D

Rationale: When one drug increases intestinal motility, it accelerates the movement of the second drug through the system. Since most oral medications are absorbed in the intestine, the faster transit time decreases the absorption of the second drug. Therefore, less of the second drug is absorbed. Choice A is incorrect because the increased gut motility does affect the absorption of the second drug. Choice C is incorrect as the effect of increased intestinal motility on drug absorption can be predicted based on pharmacokinetic principles. Choice B is incorrect as increased gut motility would not increase but decrease the absorption of the second drug.

3. A 55-year-old female asks a nurse the following, “Which mineral/vitamin is the most important to prevent the progression of osteoporosis?” The nurse should state:

• A. Potassium
• B. Magnesium
• C. Calcium
• D. Vitamin B12

Correct answer: C

Rationale: The correct answer is C: Calcium. Calcium is essential for maintaining bone health and is crucial in preventing osteoporosis. Adequate calcium intake, along with vitamin D, is vital for bone strength. While other minerals and vitamins are also important for overall health, in the context of preventing osteoporosis, calcium plays a primary role. Potassium (Choice A), Magnesium (Choice B), and Vitamin B12 (Choice D) are important for various bodily functions but are not as directly linked to preventing osteoporosis as calcium.

4. A healthcare professional is reviewing a patient's current Lithium levels. Which of the following values is outside the therapeutic range?

• A. 1.0 mEq/L
• B. 1.1 mEq/L
• C. 1.2 mEq/L
• D. 1.3 mEq/L

Correct answer: D

Rationale: The correct answer is 1.3 mEq/L. The therapeutic range for Lithium levels typically falls between 0.6 to 1.2 mEq/L. Values below or above this range can lead to suboptimal treatment outcomes or toxicity. Choices A, B, and C are within the therapeutic range of 1.0-1.2 mEq/L, making them appropriate levels for patient care.

5. A client is complaining of difficulty walking secondary to a mass in the foot. The nurse should document this finding as:

• A. Plantar fasciitis.
• B. Hallux valgus.
• C. Hammertoe.
• D. Morton's neuroma.

Correct answer: D

Rationale: The correct answer is Morton's neuroma. Morton's neuroma is a small mass or tumor in a digital nerve of the foot, causing pain and difficulty walking. Hallux valgus is commonly known as a bunion, involving a bony bump at the base of the big toe. Hammertoe is a condition where one toe is bent abnormally at the middle joint, resembling a hammer. Plantar fasciitis is characterized by pain and inflammation in the arch of the foot, not by a mass causing difficulty walking. Therefore, options A, B, and C are incorrect as they do not describe a mass in the foot leading to difficulty walking, unlike Morton's neuroma.

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