Nursing Elites

1. A nurse is preparing to administer medications to a client who has a nasogastric (NG) tube. Which of the following actions should the nurse take first?

• A. Check for tube placement.
• B. Flush the NG tube with 0.9% sodium chloride.
• C. Administer the medications as a bolus.
• D. Dissolve the medications in 30 mL of sterile water.

Correct answer: A

Rationale: The correct first action for the nurse to take when preparing to administer medications to a client with a nasogastric (NG) tube is to check for tube placement. This step is crucial to ensure that the NG tube is correctly positioned in the stomach and not in the respiratory tract, reducing the risk of aspiration. Flushing the NG tube with 0.9% sodium chloride, administering the medications as a bolus, or dissolving the medications in sterile water should only be done after confirming the proper placement of the NG tube. Therefore, options B, C, and D are incorrect as they precede the essential step of verifying tube placement.

2. A nurse is providing discharge teaching to a client who has a new prescription for digoxin. Which of the following instructions should the nurse include?

• A. Take this medication at bedtime.
• B. Take your pulse before taking this medication.
• C. Avoid eating foods high in potassium.
• D. Take this medication with an antacid.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to take their pulse before taking digoxin. This is important to monitor for bradycardia, a potential side effect of the medication. Option A is incorrect because digoxin is usually taken in the morning. Option C is unrelated to digoxin therapy, as high potassium foods are usually restricted in clients taking potassium-sparing diuretics. Option D is incorrect because digoxin should not be taken with antacids as they can affect its absorption.

3. A nurse is caring for an adolescent who has sickle-cell anemia. Which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider?

• A. Substernal retractions
• B. Hematuria
• C. Temperature of 37.9°C (100.2°F)
• D. Sneezing

Correct answer: A

Rationale: Substernal retractions indicate respiratory distress in a sickle-cell client, which can be a sign of acute chest syndrome. This condition is a serious complication of sickle-cell anemia characterized by chest pain, fever, cough, and shortness of breath. Reporting this symptom promptly is crucial for timely intervention. Choice B, hematuria, is not typically associated with acute chest syndrome but may indicate other issues such as a urinary tract infection. Choice C, a temperature of 37.9°C (100.2°F), is slightly elevated but not a specific indicator of acute chest syndrome. Choice D, sneezing, is not a typical symptom of acute chest syndrome and would not warrant immediate reporting to the provider in this context.

4. A nurse is providing dietary teaching to a client who is at 8 weeks of gestation and has a body mass index (BMI) of 24. Which of the following instructions should the nurse include?

• A. You should increase your caloric intake by 600 calories per day.
• B. You should increase your caloric intake by 300 calories per day.
• C. You should maintain your prepregnancy caloric intake during the first trimester.
• D. You should increase your caloric intake by 150 calories per day.

Correct answer: B

Rationale: During the first trimester, it is recommended to increase caloric intake by 300 calories per day to support fetal growth and development. Choice A suggesting an increase of 600 calories is excessive and unnecessary. Choice C advising to maintain prepregnancy caloric intake could lead to inadequate nutrition for the developing fetus. Choice D recommending an increase of 150 calories is insufficient to meet the increased energy demands of pregnancy.

5. A client is 24 hours postoperative following a right-sided mastectomy. Which of the following interventions should the nurse include in the plan of care?

• A. Place the client in the supine position.
• B. Encourage the client to lift objects with the right arm.
• C. Measure the client's blood pressure on the right arm.
• D. Elevate the client's right arm on a pillow.

Correct answer: D

Rationale: Elevating the client's right arm on a pillow is essential post-mastectomy to reduce swelling and promote circulation. Placing the client in the supine position may not be comfortable or ideal after a mastectomy. Encouraging the client to lift objects with the right arm can strain the surgical site and hinder healing. Measuring the client's blood pressure on the right arm should be avoided to prevent disruption to the area and inaccurate readings.

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