Nursing Elites

1. A nurse is reviewing the medication list for a client with heart failure. Which medication should the nurse question?

• A. Furosemide
• B. Digoxin
• C. Ibuprofen
• D. Carvedilol

Correct answer: C

Rationale: The correct answer is C: Ibuprofen. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can cause fluid retention, which may worsen heart failure symptoms. It should be used with caution or avoided in clients with heart failure. Furosemide (choice A) is a diuretic commonly used in heart failure to reduce fluid overload. Digoxin (choice B) is a medication that helps the heart beat stronger and slower, often used in heart failure. Carvedilol (choice D) is a beta-blocker that is beneficial in heart failure management. Therefore, Ibuprofen is the medication that the nurse should question in this scenario.

2. A 3-year-old boy was successfully toilet trained prior to his admission to the hospital for injuries sustained from a fall. His parents are very concerned that the child has regressed in his toileting behaviors. Which information should the nurse provide to the parents?

• A. Regression in toileting may indicate a neurological complication
• B. The hospital staff can assist with toilet training efforts
• C. It is common for children to regress in toileting during hospital stays
• D. A potty chair should be brought from home so he can maintain his toileting skills

Correct answer: C

Rationale: When children are hospitalized, it is common for them to regress in toileting behaviors due to the unfamiliar environment and stress. It is important for the nurse to provide reassurance to the parents in such situations. Option A is incorrect because suggesting neurological complications without evidence could cause unnecessary alarm. Option B is not the most appropriate response as the focus should be on explaining the common regression in toileting. Option D may not address the underlying reasons for the regression and may not be practical during the hospital stay.

3. A client is newly prescribed lithium for bipolar disorder. Which finding is most important to report to the healthcare provider?

• A. A serum lithium level of 1.2 mEq/L.
• B. Fine hand tremors noted after starting the medication.
• C. A blood pressure of 110/60 mmHg.
• D. A serum sodium level of 140 mEq/L.

Correct answer: B

Rationale: The correct answer is B. Fine hand tremors noted after starting lithium are an early sign of lithium toxicity. It is crucial to report this finding to the healthcare provider promptly. Adjusting the dose or monitoring serum levels more closely may be necessary to prevent further toxicity. Choice A, a serum lithium level of 1.2 mEq/L, is within the therapeutic range (0.6-1.2 mEq/L) for treating bipolar disorder. Choice C, a blood pressure of 110/60 mmHg, and Choice D, a serum sodium level of 140 mEq/L, are within normal limits and not directly related to lithium therapy or toxicity.

4. The client provides three positive responses to the CAGE questionnaire. Which interpretation should the nurse provide?

• A. The CAGE is a tool for identifying substance abuse.
• B. Two positive responses suggest alcohol dependence.
• C. One positive response indicates potential alcohol issues.
• D. All responses must be positive for alcohol dependence.

Correct answer: B

Rationale: The CAGE questionnaire is a widely used screening tool for alcohol dependence. Two or more positive responses suggest a higher likelihood of alcohol dependence. One positive response may indicate potential alcohol issues, but two or more significantly increase the likelihood of dependence. Therefore, choice B is the most appropriate interpretation. Choice A is incorrect because the CAGE questionnaire specifically focuses on alcohol-related issues, not substance abuse in general. Choice C is incorrect as one positive response does not indicate addiction but rather raises a concern. Choice D is incorrect as not all responses need to be positive to suggest alcohol dependence.

5. While changing a client's chest tube dressing, the nurse notes a cracking sensation when gentle pressure is applied to the skin at the insertion site. What is the best action for the nurse to take?

• A. Apply a pressure dressing around the chest tube site.
• B. Administer an oral antihistamine.
• C. Assess for allergies to topical cleaning agents.
• D. Measure the area of swelling and crackling.

Correct answer: D

Rationale: When a nurse observes crepitus around a chest tube site, it could indicate subcutaneous emphysema, a potentially serious condition where air gets trapped under the skin. Measuring the area of swelling and crackling is important as it helps monitor the progression of subcutaneous emphysema. Applying a pressure dressing (choice A) might not address the underlying cause and could potentially worsen the condition. Administering an oral antihistamine (choice B) is not indicated for crepitus at a chest tube site. Assessing for allergies to topical cleaning agents (choice C) is important but not the immediate priority when crepitus is observed.

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