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 with heart failure and a new prescription for furosemide is receiving teaching from a nurse. Which of the following instructions should the nurse include?

• A. Avoid foods high in magnesium
• B. Take furosemide with food
• C. Eat foods that are rich in potassium
• D. Expect a decrease in blood pressure

Correct answer: C

Rationale: The correct instruction the nurse should include is to advise the client to eat foods that are rich in potassium. Furosemide is a loop diuretic that can cause the loss of potassium, leading to hypokalemia. Eating foods high in potassium can help prevent this electrolyte imbalance. Choice A is incorrect because furosemide does not directly interact with magnesium. Choice B is incorrect because furosemide is usually taken in the morning to prevent nighttime diuresis. Choice D is incorrect because furosemide is a diuretic that typically leads to a decrease in blood pressure rather than an increase.

3. A nurse is caring for a client with a history of heroin use who is intoxicated. Which finding should the nurse expect?

• A. Constricted pupils
• B. Dilated pupils
• C. Increased reflexes
• D. Elevated blood pressure

Correct answer: A

Rationale: The correct answer is A: Constricted pupils. Constricted pupils are a classic sign of opioid intoxication, including heroin. Opioids like heroin cause the pupils to constrict due to their effect on the autonomic nervous system. Dilated pupils, increased reflexes, and elevated blood pressure are not typically associated with opioid intoxication but may be seen with other substances or conditions.

4. A client has developed a pulmonary embolism. Which of the following interventions should the nurse implement first?

• A. Administer oxygen
• B. Prepare the client for a thoracentesis
• C. Elevate the client’s lower extremities
• D. Administer anticoagulant therapy

Correct answer: A

Rationale: Administering oxygen is the priority intervention for a client with a pulmonary embolism. Pulmonary embolism can lead to impaired gas exchange, causing hypoxemia. Administering oxygen helps to maintain adequate oxygenation levels. Thoracentesis is not indicated for a pulmonary embolism, as it is a procedure to remove fluid or air from the pleural space, not a treatment for embolism. Elevating the client's lower extremities is not a priority in the management of a pulmonary embolism. Administering anticoagulant therapy is important in the treatment of pulmonary embolism to prevent further clot formation, but it is not the first intervention. Oxygen administration takes precedence to address the immediate oxygenation needs of the client.

5. A client at 28 weeks of gestation is experiencing preterm labor. Which of the following medications should the nurse plan to administer?

• A. Oxytocin
• B. Nifedipine
• C. Dinoprostone
• D. Misoprostol

Correct answer: B

Rationale: Nifedipine is the correct choice in this scenario. It is a calcium channel blocker that helps suppress uterine contractions and halt preterm labor. Nifedipine is commonly used to manage preterm labor in pregnant women by relaxing the smooth muscle of the uterus. Oxytocin (Choice A) is used to induce or augment labor, not to inhibit contractions. Dinoprostone (Choice C) and Misoprostol (Choice D) are prostaglandins used for cervical ripening and induction of labor, not for stopping preterm labor.

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