Nursing Elites

1. A nurse is caring for a client who has hypertension and is receiving enalapril. Which of the following findings should the nurse report to the provider?

• A. Increased heart rate
• B. Persistent cough
• C. Constipation
• D. Sweating

Correct answer: B

Rationale: The correct answer is B: Persistent cough. Enalapril is an ACE inhibitor that can cause a persistent cough as a common side effect. This symptom should be reported to the healthcare provider to evaluate if a medication adjustment is needed. Choices A, C, and D are not typically associated with enalapril use and are less likely to be directly related to the medication. Increased heart rate, constipation, and sweating are not commonly linked to enalapril, so they are not the priority findings to report in this case.

2. A nurse is caring for a client with dementia who frequently attempts to get out of bed unsupervised. What is the best intervention?

• A. Use restraints to prevent the client from getting out of bed
• B. Encourage family members to stay with the client at all times
• C. Use a bed exit alarm system
• D. Keep the client's room dark and quiet to reduce stimulation

Correct answer: C

Rationale: The best intervention for a client with dementia who frequently attempts to get out of bed unsupervised is to use a bed exit alarm system (Choice C). A bed exit alarm can alert staff when the client tries to leave the bed, helping to prevent falls. Using restraints (Choice A) is not recommended as it can lead to physical and psychological harm. While having family members present (Choice B) can be beneficial, it may not be feasible at all times. Keeping the client's room dark and quiet (Choice D) may not address the immediate safety concern of the client attempting to get out of bed.

3. What are the early signs and symptoms of sepsis?

• A. Increased heart rate and fever
• B. Low blood pressure and confusion
• C. Rapid breathing and sweating
• D. Abdominal pain and cyanosis

Correct answer: A

Rationale: The correct answer is A: Increased heart rate and fever. In sepsis, an increased heart rate and fever are common early signs of systemic infection. While choices B, C, and D can be present in later stages of sepsis, they are not typically the initial signs. Low blood pressure and confusion may occur in severe sepsis or septic shock. Rapid breathing and sweating can be seen as sepsis progresses. Abdominal pain and cyanosis may develop as the condition advances but are not usually the earliest signs.

4. How should a healthcare professional respond to a patient with hypokalemia?

• A. Administer potassium supplements and monitor ECG
• B. Restrict fluid intake and provide a high-sodium diet
• C. Monitor sodium levels and provide insulin therapy
• D. Provide calcium supplements and monitor for hyperkalemia

Correct answer: A

Rationale: Hypokalemia is managed by administering potassium supplements to correct the low potassium levels in the body. Monitoring the ECG is essential because low potassium levels can lead to cardiac arrhythmias. Choice B is incorrect as restricting fluid intake and providing a high-sodium diet are not appropriate for managing hypokalemia. Choice C is incorrect because hypokalemia involves low potassium levels, not sodium levels, and insulin therapy does not directly address this issue. Choice D is incorrect as calcium supplements are not indicated for hypokalemia, and monitoring for hyperkalemia is not relevant in this case.

5. A charge nurse on a medical-surgical unit is planning assignments for a licensed practical nurse (LPN) who has been sent from the postpartum unit due to a staffing shortage for the shift. Which of the following client assignments should the nurse delegate to the LPN?

• A. A client who is postoperative following a bowel resection with an NGT set to continuous suction.
• B. A client who has fractured a femur yesterday and is experiencing shortness of breath.
• C. A client who sustained a concussion and has unequal pupils.
• D. A client who has an Hgb of 6.3 g/dl and a prescription for packed RBCs.

Correct answer: A

Rationale: The correct answer is A because the LPN can care for stable clients with complex needs, such as managing an NGT set to continuous suction. Choices B, C, and D involve clients with more acute conditions that require a higher level of assessment and intervention, making them unsuitable for delegation to an LPN. Choice B requires prompt evaluation of the shortness of breath in a client with a recent femur fracture, which is beyond the LPN's scope. Choice C involves a head injury and unequal pupils, indicating the need for neurological assessment and close monitoring. Choice D relates to a critically low hemoglobin level and the need for blood transfusion, requiring careful monitoring and potential intervention beyond the LPN's role.

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