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. What are the nursing interventions for a patient with COPD?

• A. Administer oxygen and provide breathing exercises
• B. Suction airway secretions and encourage coughing
• C. Administer bronchodilators and monitor oxygen saturation
• D. Restrict fluids and encourage mobility

Correct answer: A

Rationale: The correct answer is A: Administer oxygen and provide breathing exercises. These interventions are essential in managing COPD as they help improve lung function and oxygenation. Choice B is incorrect as suctioning airway secretions and encouraging coughing are not typically indicated for COPD patients. Choice C is incorrect as while administering bronchodilators is common in COPD treatment, monitoring oxygen saturation alone is not a comprehensive intervention. Choice D is incorrect as restricting fluids is not a standard intervention for COPD, and encouraging mobility, although beneficial, is not as directly related to managing COPD symptoms as administering oxygen and providing breathing exercises.

3. A healthcare professional is preparing to transfer a client who has had a stroke and is at risk for falling to a rehabilitation facility. Which of the following information should the healthcare professional include in the transfer report?

• A. The client's urination habits.
• B. The client's financial information.
• C. The client's social history.
• D. The client's current level of mobility.

Correct answer: D

Rationale: The client's current level of mobility is essential to be included in the transfer report for the rehabilitation facility to develop an appropriate care plan. Understanding the client's mobility status helps in determining the level of assistance and interventions needed to prevent falls and promote safe rehabilitation. Choices A, B, and C are not directly related to the client's immediate care needs during the transfer to the rehabilitation facility, making them less relevant for the transfer report.

4. How should a healthcare professional manage a patient with a tracheostomy?

• A. Monitor airway patency and provide humidified oxygen
• B. Provide education on tracheostomy care
• C. Suction airway secretions and change tracheostomy ties
• D. Provide a high-protein diet and ensure fluid restriction

Correct answer: A

Rationale: Correct answer: Monitoring airway patency and providing humidified oxygen is crucial in managing a patient with a tracheostomy to ensure proper breathing and oxygenation. Ensuring the airway is clear and providing oxygen support are immediate priorities. Providing education on tracheostomy care (Choice B) is important for long-term management but not the immediate priority. Suctioning airway secretions and changing tracheostomy ties (Choice C) are tasks that may be necessary but do not address the primary concern of maintaining airway patency. Providing a high-protein diet and ensuring fluid restriction (Choice D) are unrelated to the immediate management of a tracheostomy.

5. A nurse is reviewing the medical record of a client who has schizophrenia and is taking clozapine. Which of the following findings should the nurse identify as a contraindication to the administration of clozapine?

• A. WBC count 2,900 /mm3.
• B. Fasting blood glucose 100 mg/dl.
• C. Hgb 14 g/dl.
• D. Heart rate 58/min.

Correct answer: A

Rationale: A WBC count of 2,900/mm3 indicates leukopenia, which is a serious side effect of clozapine and contraindicates its use. Leukopenia is a significant concern with clozapine therapy due to the risk of agranulocytosis, a potentially life-threatening condition. Monitoring the WBC count is crucial to detect this adverse effect early. The other options (B, C, and D) are within normal ranges and not contraindications for administering clozapine.

Similar Questions