Nursing Elites

1. A nurse is caring for a client with congestive heart failure. Which of the following prescriptions should the nurse anticipate?

• A. Call the provider if the respiratory rate is less than 18/min
• B. Administer a 500 mL IV bolus of 0.9% sodium chloride over 1 hour
• C. Administer enalapril 2.5 mg PO twice daily
• D. Call the provider if the client’s pulse rate is less than 80/min

Correct answer: C

Rationale: Enalapril, an ACE inhibitor, is commonly prescribed to manage hypertension and heart failure. It helps reduce the workload on the heart and prevent fluid retention. Options A, B, and D are incorrect. Option A focuses on a respiratory rate, which is not specific to heart failure management. Option B suggests administering a large IV bolus of fluid, which can worsen heart failure by increasing fluid volume. Option D addresses the pulse rate, which is not a typical parameter to monitor for heart failure specifically.

2. A client who has undergone a cesarean birth is receiving discharge instructions from a nurse. Which of the following should the nurse include in the instructions?

• A. Limit stair climbing for the first few weeks
• B. Avoid lifting anything heavier than the newborn
• C. Use a pillow to support the abdomen when coughing or sneezing
• D. All of the above

Correct answer: D

Rationale: After a cesarean birth, it is important for the client to follow specific instructions for optimal recovery. Limiting stair climbing reduces strain on the incision site, aiding in healing (Choice A). Avoiding lifting anything heavier than the newborn prevents stress on the incision, promoting recovery (Choice B). Using a pillow to support the abdomen during coughing or sneezing helps reduce discomfort and protect the incision, preventing sudden movements or strain (Choice C). Therefore, all the options provided are crucial post-cesarean birth instructions to ensure proper healing and recovery. Choices A, B, and C are all essential components of post-cesarean care, making Option D the correct answer.

3. A client who is at 32 weeks gestation and has a history of cardiac disease is being cared for by a nurse. Which of the following positions should the nurse place the client in to best promote optimal cardiac output?

• A. The chest
• B. Standing
• C. Supine
• D. Left lateral

Correct answer: D

Rationale: The correct answer is the left lateral position. Placing the client in the left lateral position promotes optimal cardiac output during pregnancy by reducing pressure on the inferior vena cava, improving blood flow to the heart and fetus. Choice A, 'The chest,' is incorrect as it does not describe a position that benefits cardiac output. Choice B, 'Standing,' is incorrect as it does not alleviate pressure on the vena cava. Choice C, 'Supine,' is contraindicated in pregnancy, especially in clients with cardiac disease, as it can compress the vena cava and decrease cardiac output.

4. A nurse is providing discharge teaching to a client who is starting to take carbidopa/levodopa to treat Parkinson’s disease. Which of the following instructions should the nurse include in the teaching?

• A. “This medication can cause your urine to turn a dark color.”
• B. “Expect immediate relief after taking this medication.”
• C. “Take the medication with a high-protein food.”
• D. “Skip a dose of the medication if you experience dizziness.”

Correct answer: A

Rationale: The correct instruction the nurse should provide is that the medication can cause the client's urine to turn a dark color, which is a harmless effect of carbidopa/levodopa. This is due to the metabolites of levodopa. Immediate relief is not expected after taking the medication because it may take weeks to months to achieve the full therapeutic effect. Taking the medication with a high-protein food is not recommended as protein can interfere with the absorption of levodopa. Skipping a dose of the medication if the client experiences dizziness is incorrect as dizziness may be a side effect of the medication, and doses should not be skipped without consulting a healthcare provider.

5. A nurse receives a change-of-shift report. Which of the following clients should the nurse attend to first?

• A. A client who reports tingling in the fingers following a thyroidectomy
• B. A client who has dark, foul-smelling urine with a urine output of 320 mL in the last 8 hr
• C. A client who is in a long leg cast and reports cool feet bilaterally
• D. A client who has a productive cough and an oral temperature of 36°C (96.8°F)

Correct answer: C

Rationale: The correct answer is C. Cool feet bilaterally in a client with a long leg cast may indicate compromised circulation, which is a medical emergency that requires immediate intervention. Choices A, B, and D do not present immediate life-threatening conditions. Tingling in the fingers following a thyroidectomy may indicate hypocalcemia but does not require immediate attention. Dark, foul-smelling urine with decreased urine output indicates a possible urinary tract infection or dehydration but can be addressed after attending to the client with compromised circulation. A productive cough and a normal oral temperature do not suggest an urgent condition compared to compromised circulation in a client with a long leg cast.

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