Nursing Elites

1. A nurse is caring for a client who has coronary artery disease (CAD) and is receiving aspirin therapy. Which of the following findings should the nurse report to the provider?

• A. History of gastrointestinal bleeding
• B. Prothrombin time of 12 seconds
• C. Platelet count of 180,000/mm³
• D. Creatinine level of 1.0 mg/dL

Correct answer: A

Rationale: The correct answer is A: History of gastrointestinal bleeding. Aspirin therapy is contraindicated in clients with a history of gastrointestinal bleeding because aspirin can further increase the risk of bleeding. Option B, prothrombin time of 12 seconds, is within the normal range and does not indicate a concern related to aspirin therapy. Option C, platelet count of 180,000/mm³, is also within the normal range and does not suggest a need for reporting to the provider in the context of aspirin therapy. Option D, creatinine level of 1.0 mg/dL, is within the normal range and is not directly related to aspirin therapy in this scenario.

2. Which of the following situations can be identified as an ethical dilemma?

• A. A nurse demonstrates signs of chemical impairment
• B. A family has conflicting feelings about tube feeding for their terminally ill father
• C. A nurse overhears a colleague threatening to restrain a patient if they do not stay in bed
• D. A client with terminal cancer hesitates to name their spouse as power of attorney

Correct answer: B

Rationale: The correct answer is B. Ethical dilemmas involve conflicting values or feelings. In this situation, the family is conflicted about tube feeding for their terminally ill father, which presents a moral and ethical challenge. Choices A, C, and D do not represent ethical dilemmas. Choice A involves a nurse's impairment, which is a different issue. Choice C involves a nurse's observation of a colleague's threat, which is a patient safety concern. Choice D involves a client's hesitation in naming a spouse as power of attorney, which is a legal and decision-making issue, not necessarily an ethical dilemma.

3. While caring for a client with an IV infusion who develops redness and warmth at the IV site, what is the most appropriate intervention?

• A. Elevate the IV site and apply an ice pack
• B. Administer an anti-inflammatory medication
• C. Apply a cold compress to the IV site
• D. Discontinue the IV and notify the provider

Correct answer: D

Rationale: The correct intervention when a client develops redness and warmth at the IV site, indicating phlebitis, is to discontinue the IV and notify the provider. This is crucial to prevent further complications. Elevating the IV site and applying an ice pack (Choice A) may not address the underlying issue of phlebitis. Administering an anti-inflammatory medication (Choice B) is not the primary intervention for phlebitis. Applying a cold compress (Choice C) may provide temporary relief but does not address the need to discontinue the IV when phlebitis occurs.

4. How can pain in a post-operative patient be managed effectively?

• A. Administer analgesics as prescribed
• B. Encourage deep breathing exercises
• C. Provide distractions
• D. All of the above

Correct answer: D

Rationale: Managing pain in a post-operative patient requires a multimodal approach, which includes both pharmacological and non-pharmacological strategies. Administering analgesics as prescribed helps in controlling pain pharmacologically. Encouraging deep breathing exercises can aid in pain management by promoting relaxation and reducing anxiety. Providing distractions, such as music or activities, can help divert the patient's attention from pain. Therefore, all the given options are essential components of an effective pain management plan for post-operative patients.

5. What is the first step in managing a client with delirium?

• A. Administer sedative medication to calm the client
• B. Identify any reversible causes of delirium
• C. Limit environmental stimulation to reduce anxiety
• D. Administer antipsychotic medication to control behavior

Correct answer: B

Rationale: The correct first step in managing a client with delirium is to identify any reversible causes of delirium. This is crucial because addressing the underlying cause can help in resolving delirium more effectively. Administering sedative or antipsychotic medications without addressing the root cause may not be helpful and can even worsen the condition. Limiting environmental stimulation, although important, is not the primary step in managing delirium.

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