Nursing Elites

1. A healthcare provider is preparing to administer a scheduled dose of intravenous (IV) metoprolol (Lopressor) to a client. The client's apical pulse is 58 beats/minute. What action should the healthcare provider take?

• A. Administer the medication as prescribed.
• B. Hold the medication and notify the healthcare provider.
• C. Give half the prescribed dose and recheck the pulse in 30 minutes.
• D. Administer the medication and then recheck the pulse in 30 minutes.

Correct answer: B

Rationale: In the scenario described, with the client's apical pulse being 58 beats/minute, holding the medication and notifying the healthcare provider is the correct action. A low pulse rate may indicate bradycardia and may necessitate dose adjustment or further evaluation by the healthcare provider to prevent potential complications.

2. The healthcare professional is caring for a client with a chest tube following a thoracotomy. Which assessment finding requires immediate intervention?

• A. Continuous bubbling in the water seal chamber.
• B. Serosanguineous drainage in the collection chamber.
• C. Intermittent bubbling in the suction control chamber.
• D. Chest tube secured to the client's chest wall.

Correct answer: A

Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which requires immediate intervention to prevent complications such as pneumothorax. An air leak can lead to ineffective lung expansion, respiratory distress, and compromised gas exchange. Therefore, prompt action is necessary to maintain the integrity of the closed drainage system and prevent further complications. Choices B, C, and D are incorrect because serosanguineous drainage is an expected finding post-thoracotomy, intermittent bubbling in the suction control chamber is normal, and having the chest tube secured to the client's chest wall is essential for stability and proper functioning.

3. The preceptor is orienting a new graduate nurse to the critical care unit. The preceptor asks the new graduate to state symptoms that most likely indicate the beginning of a shock state in a critically ill client. What findings should the new graduate nurse identify?

• A. Warm skin, hypertension, and constricted pupils.
• B. Bradycardia, hypotension, and respiratory acidosis.
• C. Mottled skin, tachypnea, and hyperactive bowel sounds.
• D. Tachycardia, mental status change, and low urine output.

Correct answer: D

Rationale: Tachycardia, mental status change, and low urine output are early indicators of shock. In a critically ill client, these findings suggest a decrease in tissue perfusion. Prompt recognition and intervention are crucial to prevent the progression of shock and its complications.

4. The client has just been diagnosed with Addison's disease. Which clinical manifestation should the nurse expect to find?

• A. Hypertension and hyperglycemia.
• B. Hyperpigmentation and hypotension.
• C. Exophthalmos and tachycardia.
• D. Weight gain and fluid retention.

Correct answer: B

Rationale: Hyperpigmentation and hypotension are classic clinical manifestations of Addison's disease due to decreased cortisol production. Hyperpigmentation occurs due to elevated levels of ACTH, leading to increased melanin synthesis. Hypotension results from aldosterone deficiency, causing sodium loss and volume depletion.

5. A client is being educated about type 2 diabetes. The educator can confirm that the client understands the primary treatment for type 2 diabetes when the client states what?

• A. I read that a pancreas transplant will provide a cure for my diabetes.
• B. I will take my oral antidiabetic agents when my morning blood sugar is high.
• C. I will make sure to follow the weight loss plan designed by the dietitian.
• D. I will make sure I call the diabetes educator when I have questions about my insulin.

Correct answer: C

Rationale: The primary treatment approach for managing type 2 diabetes includes following a weight loss plan. Weight loss can improve insulin sensitivity and glycemic control in individuals with type 2 diabetes. Making dietary changes and maintaining a healthy weight are crucial components of managing this condition.

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