Nursing Elites

1. A nurse is reviewing the medical record of a client who has a new prescription for spironolactone. Which of the following findings should the nurse report to the provider?

• A. Potassium 4.0 mEq/L
• B. Calcium 9.5 mg/dL
• C. Magnesium 2.0 mEq/L
• D. Serum creatinine 3.0 mg/dL

Correct answer: D

Rationale: A serum creatinine level of 3.0 mg/dL indicates impaired kidney function, which is a concern when prescribing spironolactone as it can further affect renal function. Elevated serum creatinine levels may suggest decreased renal clearance of spironolactone, leading to potential toxicity. Potassium, calcium, and magnesium levels are within normal ranges and not directly related to spironolactone therapy. Therefore, the nurse should report the elevated serum creatinine level to the provider for further evaluation and possible dosage adjustment.

2. While caring for a client receiving an opioid analgesic for pain management, which assessment should the nurse prioritize?

• A. Monitor the client's urinary output.
• B. Check the client's blood pressure.
• C. Assess the client for constipation.
• D. Monitor the client's respiratory rate.

Correct answer: D

Rationale: The correct answer is to monitor the client's respiratory rate. When a client is receiving opioids, the priority assessment is the respiratory rate since opioids can lead to respiratory depression. Monitoring urinary output, blood pressure, and constipation are also important but not the priority in this scenario.

3. What is the appropriate nursing response when a patient refuses blood transfusion due to religious beliefs?

• A. Respect the patient's decision and notify the provider
• B. Attempt to persuade the patient to accept the transfusion
• C. Document the refusal and notify the healthcare provider
• D. Provide education on the benefits of blood transfusion

Correct answer: A

Rationale: The correct answer is A: "Respect the patient's decision and notify the provider." When a patient refuses a blood transfusion due to religious beliefs, it is essential to respect their autonomy and religious beliefs. Attempting to persuade the patient (Choice B) goes against the principle of respect for autonomy and can lead to ethical dilemmas. Documenting the refusal and notifying the healthcare provider (Choice C) is important for legal and ethical purposes but should be preceded by respecting the patient's decision. Providing education on the benefits of blood transfusion (Choice D) may be appropriate in other situations but is not indicated when a patient refuses based on religious beliefs.

4. A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

• A. Take this medication with meals to prevent nausea.
• B. Avoid drinking alcohol while taking this medication.
• C. Avoid eating foods high in potassium.
• D. Monitor for signs of infection.

Correct answer: D

Rationale: The correct answer is D: 'Monitor for signs of infection.' Clopidogrel affects platelet levels, increasing the risk of bleeding. Therefore, it is essential for clients taking clopidogrel to monitor for signs of infection, which could indicate a lowered immune response. Choices A, B, and C are incorrect because they do not directly relate to the specific monitoring needs associated with clopidogrel therapy.

5. What is the most important nursing action for a patient presenting with confusion after surgery?

• A. Administer oxygen
• B. Reposition the patient
• C. Administer IV fluids
• D. Perform a neurological assessment

Correct answer: A

Rationale: Administering oxygen is crucial for a patient presenting with confusion after surgery because it helps alleviate potential hypoxia, which can be a common cause of confusion in the postoperative period. While repositioning the patient, administering IV fluids, and performing a neurological assessment are important nursing interventions in certain situations, addressing hypoxia by administering oxygen takes priority in this case to ensure an adequate oxygen supply to the brain and other vital organs.

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