Nursing Elites

1. A nurse is caring for an infant who has coarctation of the aorta. Which of the following should the nurse identify as an expected finding?

• A. Weak femoral pulses.
• B. Frequent nosebleeds.
• C. Upper extremity hypotension.
• D. Increased intracranial pressure.

Correct answer: A

Rationale: Corrected Rationale: Weak femoral pulses are an expected finding in an infant with coarctation of the aorta. The narrowing of the aorta leads to decreased blood flow to the lower extremities, resulting in weak or absent femoral pulses. Frequent nosebleeds (Choice B) are not typically associated with coarctation of the aorta. Upper extremity hypotension (Choice C) is not a common finding in coarctation of the aorta; instead, blood pressure is usually elevated in the upper extremities. Increased intracranial pressure (Choice D) is not directly related to coarctation of the aorta.

2. What is the most important nursing action when a patient experiences a fall?

• A. Assess the patient for injuries
• B. Call for help
• C. Document the fall
• D. Notify the healthcare provider

Correct answer: A

Rationale: The most important nursing action when a patient experiences a fall is to assess the patient for injuries. This is critical to identify any potential harm or underlying issues that may require immediate attention. Calling for help and notifying the healthcare provider are important steps, but assessing the patient's condition takes precedence to ensure prompt and appropriate care. Documenting the fall is also necessary but should follow the initial assessment and care provided to the patient.

3. What is the best initial nursing intervention for a patient with suspected pulmonary embolism?

• A. Administer oxygen
• B. Administer anticoagulants
• C. Reposition the patient
• D. Check oxygen saturation

Correct answer: A

Rationale: Administering oxygen is the best initial nursing intervention for a patient with suspected pulmonary embolism because it helps address hypoxia, a common complication of this condition. Oxygen therapy can improve oxygenation and support vital organ function. Administering anticoagulants (Choice B) is a treatment option for confirmed pulmonary embolism but not the initial intervention. Repositioning the patient (Choice C) and checking oxygen saturation (Choice D) are important assessments but do not address the immediate need to improve oxygenation in a patient with suspected pulmonary embolism.

4. A nurse is caring for a client who is 1 hour postpartum. Which of the following findings should the nurse report to the provider?

• A. Fundus firm and at the umbilicus.
• B. Heart rate 80/min.
• C. Blood pressure 130/78 mm Hg.
• D. A constant trickle of bright red blood from the vagina.

Correct answer: D

Rationale: After childbirth, it is normal for the fundus to be firm and at the level of the umbilicus, heart rate to be around 80/min, and blood pressure to be slightly elevated. However, a constant trickle of bright red blood from the vagina is concerning as it could indicate postpartum hemorrhage. This finding should be reported promptly to the healthcare provider for further evaluation and intervention. Choices A, B, and C are within expected postpartum parameters and do not indicate an immediate need for intervention.

5. A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will avoid aspirin while taking this medication.
• B. I will increase my intake of green leafy vegetables.
• C. I will take this medication with an antacid.
• D. I should expect mild bruising around my elbows.

Correct answer: A

Rationale: The correct answer is A: "I will avoid aspirin while taking this medication." Clients taking warfarin should avoid aspirin due to the increased risk of bleeding. Choice B is incorrect because increasing the intake of green leafy vegetables high in Vitamin K can interfere with the effects of warfarin. Choice C is incorrect because warfarin should not be taken with antacids as they can decrease its absorption. Choice D is incorrect because mild bruising is a common side effect of warfarin due to its anticoagulant properties.

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