Nursing Elites

1. An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?

• A. Prescribe an inexpensive NSAID alone
• B. Prescribe an inexpensive NSAID and misoprostol
• C. Prescribe celecoxib
• D. Prescribe an inexpensive NSAID and sucralfate

Correct answer: A

Rationale: In this scenario, the most appropriate treatment plan would be to prescribe an inexpensive NSAID alone. While the elderly woman is at a higher risk of developing NSAID-related toxicity, prophylaxis with misoprostol or sucralfate is not recommended in the absence of a history of peptic ulcer disease or abdominal symptoms. Celecoxib, a selective COX-2 inhibitor, may be a more expensive option than traditional NSAIDs. Considering the patient's preference for the most inexpensive option and the lack of specific risk factors, starting with a standalone NSAID is the most suitable approach.

2. A 62-year-old male client with a history of coronary artery disease complains that his heart is 'racing' and he often feels dizzy. His blood pressure is 110/60, and he uses portable oxygen at 2 liters per nasal cannula. Based on the rhythm shown, which prescription should the nurse administer?

• A. Give magnesium via secondary infusion.
• B. Initiate IV heparin solution as per protocol.
• C. Administer IV adenosine (Adenocard).
• D. Prepare for synchronized cardioversion.

Correct answer: C

Rationale: Administering IV adenosine is the appropriate intervention for a client with symptomatic tachycardia to restore normal sinus rhythm. Adenosine is a medication used to treat supraventricular tachycardia (SVT) by interrupting the reentry pathways through the AV node and restoring normal sinus rhythm. It is a rapid-acting medication given as a rapid IV push followed by a saline flush. The dose is typically administered in a healthcare setting where cardiac monitoring is available due to its potential to cause transient asystole.

3. A client who is receiving heparin therapy has an activated partial thromboplastin time (aPTT) of 90 seconds. What action should the nurse take?

• A. Increase the heparin infusion rate.
• B. Notify the healthcare provider.
• C. Apply pressure to the injection site.
• D. Administer protamine sulfate.

Correct answer: B

Rationale: An activated partial thromboplastin time (aPTT) of 90 seconds is elevated, indicating a risk of bleeding. The appropriate action for the nurse is to notify the healthcare provider. Increasing the heparin infusion rate can further elevate the aPTT, leading to an increased risk of bleeding. Applying pressure to the injection site is not relevant in this situation. Administering protamine sulfate is used to reverse the effects of heparin in cases of overdose or bleeding, but it is not the initial action for an elevated aPTT.

4. A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?

• A. Administer acetaminophen (Tylenol).
• B. Apply lotion to the skin.
• C. Encourage a high-protein diet.
• D. Provide a warm bath.

Correct answer: B

Rationale: Pruritus is a common symptom in clients with cirrhosis due to bile salts accumulating in the skin. Applying lotion to the skin helps soothe the itching and can prevent skin breakdown. Acetaminophen can worsen liver damage in clients with cirrhosis as it is metabolized in the liver. Encouraging a high-protein diet is not directly related to relieving pruritus. Providing a warm bath may further dry the skin, exacerbating the itching. Therefore, the most appropriate intervention to help relieve pruritus in a client with cirrhosis is to apply lotion to the skin.

5. An elderly male client reports to the clinic nurse that he is experiencing increasing nocturia with difficulty initiating his urine stream. He reports a weak urine flow and frequent dribbling after voiding. Which nursing action should be implemented?

• A. Obtain a urine specimen for culture and sensitivity.
• B. Encourage the client to schedule a digital rectal exam.
• C. Advise the client to maintain a voiding diary for one week.
• D. Instruct the client in effective techniques for cleansing the glans penis.

Correct answer: B

Rationale: Encouraging the client to schedule a digital rectal exam is the most appropriate nursing action in this situation. This exam can help evaluate for potential prostate enlargement or other issues contributing to the urinary symptoms described by the client. It is important to assess the prostate gland for any abnormalities that may be causing the urinary issues reported by the client.

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