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 nurse at a provider’s office is interviewing a client who has multiple sclerosis and has been taking dantrolene for several months. Which of the following client statements should the nurse identify as an indication that the medication is effective?

• A. “I don’t have muscle spasms as frequently.”
• B. “I haven’t gotten any colds, even though it is flu season.”
• C. “I feel like my nerve pain has improved.”
• D. “It is easier to urinate now.”

Correct answer: A

Rationale: The correct answer is A: "I don’t have muscle spasms as frequently." The nurse should identify that dantrolene relaxes skeletal muscles, so a decrease in muscle spasms indicates the medication is effective. Choice B is incorrect as cold prevention is not related to dantrolene. Choice C is incorrect because nerve pain improvement is not a direct effect of dantrolene. Choice D is incorrect as dantrolene's action does not affect urination.

3. A client wearing an arm cast reports numb fingers. Which of the following actions should the nurse take first?

• A. Place the arm in a dependent position
• B. Administer pain medication
• C. Check the client's circulation
• D. Apply a warm compress to the fingers

Correct answer: C

Rationale: The correct answer is to check the client's circulation. Numbness in the fingers may indicate compromised circulation or nerve damage. By assessing the circulation first, the nurse can ensure that the cast is not too tight, which could be cutting off blood flow. Option A is incorrect because placing the arm in a dependent position may worsen circulation issues. Option B is incorrect as administering pain medication does not address the underlying cause of numbness. Option D is incorrect as applying a warm compress could mask circulation issues and is not the priority in this situation.

4. A client is prescribed propranolol. Which of the following client history findings would require the nurse to clarify this medication prescription?

• A. Asthma
• B. Hypertension
• C. Tachydysrhythmias
• D. Urolithiasis

Correct answer: A

Rationale: Corrected Rationale: Propranolol, a non-selective beta-blocker, should be avoided in clients with asthma as it can cause bronchoconstriction due to its beta2-blocking effects. Therefore, a client history finding of asthma would require the nurse to clarify this medication prescription. Hypertension, tachydysrhythmias, and urolithiasis are not contraindications for propranolol use, making them incorrect choices. For clients with asthma, a beta1 selective blocker would be preferred to avoid exacerbating bronchoconstriction.

5. A nurse on a postpartum unit is receiving change-of-shift report for four clients. Which of the following clients should the nurse see first?

• A. A client who gave birth 1 day ago and needs Rho(D) immune globulin
• B. A client who gave birth 3 days ago and reports breast fullness
• C. A client who gave birth 12 hours ago and reports an increase in urinary output
• D. A client who gave birth 8 hours ago and is saturating a perineal pad every hour

Correct answer: D

Rationale: The nurse should see the client saturating a perineal pad every hour first. This client may be experiencing postpartum hemorrhage, which is a medical emergency requiring immediate assessment and intervention. The other options describe clients with less urgent needs. The client needing Rho(D) immune globulin can wait, the breast fullness in the client who gave birth 3 days ago can be addressed after managing the postpartum hemorrhage, and an increase in urinary output in a client who gave birth 12 hours ago is not indicative of an immediate emergency like postpartum hemorrhage.

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