Nursing Elites

1. A client is prescribed clopidogrel. What laboratory result should be monitored by the nurse?

• A. White blood cell count
• B. Creatinine
• C. Blood glucose
• D. Platelet count

Correct answer: D

Rationale: When a client is prescribed clopidogrel, monitoring the platelet count is essential. Clopidogrel is an antiplatelet medication that works by preventing blood clots. Monitoring the platelet count is crucial in assessing the risk of thrombocytopenia, a potential side effect of clopidogrel. Monitoring white blood cell count, creatinine, or blood glucose is not directly related to the action or side effects of clopidogrel, making choices A, B, and C incorrect.

2. A healthcare provider is assisting in the care of a client who is having central venous pressure (CVP) measurements taken. The healthcare provider should assist by placing the bed in which position for the reading?

• A. Flat
• B. Semi-Fowler's
• C. Trendelenburg
• D. Reverse Trendelenburg

Correct answer: A

Rationale: Central venous pressure (CVP) measurements are most accurate when the client is lying flat, as this allows for a consistent baseline. Placing the bed flat ensures that the hydrostatic pressure within the vena cava is not affected by the client's position, providing a more precise reading. Choice B (Semi-Fowler's) elevates the head of the bed at a 30-45 degree angle, which could affect the accuracy of CVP readings. Choices C (Trendelenburg) and D (Reverse Trendelenburg) involve extreme positions that would not be suitable for obtaining accurate CVP measurements.

3. An ambulatory clinic nurse is interviewing a client who is complaining of flu-like symptoms. The client suddenly develops chest pain. Which question best assists the nurse in discriminating pain caused by a non-cardiac problem?

• A. Can you describe the pain to me?
• B. Have you ever experienced this pain before?
• C. Does the pain get worse when you breathe in?
• D. Can you rate the pain on a scale of 1 to 10, with 10 being the worst?

Correct answer: C

Rationale: The correct answer is C. Pain that worsens with breathing in can indicate pleuritic chest pain, which is non-cardiac in nature. This specific question helps in differentiating non-cardiac causes from cardiac causes of chest pain, as cardiac pain typically does not worsen with breathing. Choices A, B, and D are less specific in discriminating between cardiac and non-cardiac chest pain.

4. A client with a history of heart failure is admitted with a diagnosis of pulmonary edema. Which intervention should the LPN/LVN expect to assist with first?

• A. Administer a diuretic as prescribed.
• B. Place the client in a high Fowler's position.
• C. Prepare the client for intubation.
• D. Insert an indwelling urinary catheter.

Correct answer: B

Rationale: In a client with pulmonary edema, placing them in a high Fowler's position is the priority intervention. This position helps to improve ventilation and oxygenation by decreasing venous return, reducing the workload on the heart, and facilitating fluid redistribution from the lungs. It is crucial to optimize respiratory function and oxygenation before considering other interventions like administering medications, preparing for intubation, or inserting a urinary catheter. Administering a diuretic, preparing for intubation, or inserting a urinary catheter may be necessary but should follow the priority of improving oxygenation through positioning.

5. When assessing a client receiving total parenteral nutrition (TPN), which laboratory value is most important for the nurse to monitor regularly?

• A. Albumin
• B. Calcium
• C. Glucose
• D. Alkaline phosphatase

Correct answer: C

Rationale: The most important laboratory value to monitor regularly in clients receiving total parenteral nutrition (TPN) is glucose. TPN solutions contain high concentrations of glucose, which can lead to hyperglycemia. Monitoring glucose levels is crucial to detect and prevent hyperglycemia, a common complication associated with TPN administration. Albumin (Choice A) levels are not typically affected by TPN administration. Calcium (Choice B) and alkaline phosphatase (Choice D) are not directly impacted by TPN and are not the primary values to monitor in TPN therapy.

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