Nursing Elites

1. For a patient with asthma, what is the primary purpose of prescribing montelukast?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Thin respiratory secretions
• D. Suppress cough

Correct answer: B

Rationale: Montelukast, a leukotriene receptor antagonist, is primarily prescribed to prevent asthma attacks. It works by reducing inflammation and bronchoconstriction in the airways, thereby helping to control asthma symptoms and prevent exacerbations.

2. A client with left-sided heart failure is experiencing dyspnea and orthopnea. Which position should the nurse place the client in to relieve these symptoms?

• A. High Fowler's position.
• B. Supine position.
• C. Trendelenburg position.
• D. Sims' position.

Correct answer: A

Rationale: Placing the client in High Fowler's position is beneficial for individuals with left-sided heart failure experiencing dyspnea and orthopnea. This position helps to reduce venous return, decrease preload, and enhance respiratory function, thereby relieving the symptoms mentioned. Choice B, the supine position, is not recommended as it may exacerbate dyspnea and orthopnea by increasing preload. Choice C, the Trendelenburg position, is incorrect as it involves the feet being positioned higher than the head, which is not suitable for heart failure patients. Choice D, the Sims' position, is a lateral position used for rectal examination and is not indicated for relieving dyspnea and orthopnea in heart failure.

3. A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response?

• A. Administer a Fleet enema as prescribed and remain with the client
• B. Contact the primary care provider promptly and report these signs of perforation
• C. Position the client supine and insert an NG tube
• D. Page the primary provider and report that the client may be obstructed

Correct answer: B

Rationale: In a client with acute diverticulitis experiencing sudden increase in temperature, exquisite abdominal tenderness, and uncharacteristic abdominal rigidity, these signs suggest a possible perforation. The nurse should promptly contact the primary care provider to report these signs, as perforation requires immediate medical attention to prevent further complications.

4. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate?

• A. Bounding erratic pulse.
• B. Regularly irregular pulse.
• C. Thready irregular pulse.
• D. No palpable pulse.

Correct answer: D

Rationale: Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, asynchronous contractions of the ventricles, resulting in ineffective cardiac output. This leads to the absence of a palpable pulse. Nurses should be prepared to initiate immediate interventions such as defibrillation to restore normal cardiac rhythm in a client experiencing ventricular fibrillation.

5. A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?

• A. NSAIDs
• B. Alendronate
• C. Iron sulfate
• D. Calcium channel blocker

Correct answer: D

Rationale: In this case, the least likely contributor to the condition described is the calcium channel blocker. NSAIDs, alendronate, and iron sulfate have been associated with pill-induced esophagitis, which can present with symptoms like odynophagia and erosions or ulcers on imaging studies. Pill-induced esophagitis is often due to factors like inadequate water intake with the medication, being in a supine position, or underlying motility disorders. Discontinuation of the offending medication typically leads to rapid resolution of esophageal injury. Acid-suppressive therapy may be used to prevent reflux-related damage.

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