Nursing Elites

1. A patient with severe pain is prescribed morphine sulfate. What is the most important side effect for the nurse to monitor?

• A. Diarrhea
• B. Hypertension
• C. Respiratory depression
• D. Increased urine output

Correct answer: C

Rationale: When a patient is prescribed morphine sulfate, the most critical side effect for the nurse to monitor is respiratory depression. Morphine can suppress the respiratory drive, leading to inadequate ventilation and potentially life-threatening consequences. Monitoring the patient's respiratory status closely is essential to promptly identify and manage any signs of respiratory depression.

2. The nurse is caring for four clients: Client A, who has emphysema and an oxygen saturation of 94%; Client B, with a postoperative hemoglobin of 8.7 g/dL; Client C, newly admitted with a potassium level of 3.8 mEq/L; and Client D, scheduled for an appendectomy with a white blood cell count of 15,000/mm3. What intervention should the nurse implement?

• A. Increase Client A's oxygen to 4 liters per minute via nasal cannula.
• B. Determine if Client B has two units of packed cells available in the blood bank.
• C. Ask the dietitian to add a banana to Client C's breakfast tray.
• D. Inform Client D that surgery is likely to be delayed until the infection is treated.

Correct answer: D

Rationale: A high white blood cell count, as seen in Client D, indicates infection, which may require postponing surgery to treat the infection adequately. It is crucial to address the underlying infection before proceeding with the appendectomy to prevent complications and ensure a successful surgical outcome.

3. The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at low risk for reinfection with H. pylori
• B. A positive serum IgG indicates that eradication of H. pylori was successful
• C. The urease breath test is an ideal test to document failure of eradication
• D. Dyspepsia typically worsens with H. pylori eradication

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a decrease in quantitative IgG levels has been utilized to indicate treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure due to their high sensitivity, specificity, and ease of performance. The relationship between dyspepsia and H. pylori is controversial, but generally, dyspepsia does not typically improve with H. pylori eradication.

4. A patient with schizophrenia is prescribed olanzapine. What is an important side effect for the healthcare provider to monitor?

• A. Hypertension
• B. Weight gain
• C. Hypoglycemia
• D. Bradycardia

Correct answer: B

Rationale: The correct answer is B: Weight gain. Olanzapine, an atypical antipsychotic, is known to cause significant weight gain and metabolic syndrome. It is crucial for healthcare providers to closely monitor patients for these side effects to prevent complications and provide appropriate interventions.

5. After performing a paracentesis on a client with ascites, 3 liters of fluid are removed. Which assessment parameter is most critical for the nurse to monitor following the procedure?

• A. Pedal pulses.
• B. Breath sounds.
• C. Gag reflex.
• D. Vital signs.

Correct answer: D

Rationale: Following a paracentesis where a significant amount of fluid is removed, it is crucial to monitor the client's vital signs. This helps in detecting any signs of hypovolemia, such as changes in blood pressure, heart rate, and respiratory rate, which could indicate complications post-procedure. Monitoring the vital signs allows for prompt intervention if there are any deviations from the baseline values.

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