Nursing Elites

1. The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient?

• A. Digoxin (Lanoxin)
• B. Furosemide (Lasix)
• C. Hydrochlorothiazide (HydroDIURIL)
• D. Spironolactone (Aldactone)

Correct answer: B

Rationale: In heart failure with marked edema and low urine output, the nurse can expect the provider to order Furosemide (Lasix). Furosemide is a loop diuretic that acts quickly to remove excess fluid from the body, making it an appropriate choice for this patient's condition. Digoxin is used to improve heart function but does not directly address fluid overload. Hydrochlorothiazide is a thiazide diuretic that is not as potent as Furosemide in managing acute fluid retention. Spironolactone is a potassium-sparing diuretic that is typically used in heart failure for its aldosterone-blocking effects and not for immediate fluid removal.

2. After the administration of t-PA, what should the nurse do?

• A. Observe the client for chest pain.
• B. Monitor for fever.
• C. Review the 12-lead electrocardiogram (ECG).
• D. Auscultate breath sounds.

Correct answer: A

Rationale: After the administration of t-PA, the nurse should observe the client for chest pain. Chest pain post t-PA administration could indicate reocclusion of the coronary artery, a serious complication that requires immediate intervention. Monitoring for fever (choice B) is not specifically associated with t-PA administration. While reviewing the 12-lead ECG (choice C) is important for assessing cardiac function, it may not be the immediate priority right after t-PA administration. Auscultating breath sounds (choice D) is important for assessing respiratory status but is not the most crucial assessment following t-PA administration.

3. A client has been scheduled for magnetic resonance imaging (MRI). For which of the following conditions, a contraindication to MRI, does the nurse check the client’s medical history?

• A. Pancreatitis
• B. Pacemaker insertion
• C. Type 1 diabetes mellitus
• D. Chronic airway limitation

Correct answer: B

Rationale: The correct answer is B: Pacemaker insertion. Patients with metal devices or implants are contraindicated for MRI. These include pacemakers, orthopedic hardware, artificial heart valves, aneurysm clips, and intrauterine devices. These metal objects can be affected by the strong magnetic field of the MRI, leading to serious risks for the patient. Pancreatitis (choice A), Type 1 diabetes mellitus (choice C), and chronic airway limitation (choice D) are not contraindications to MRI based on the presence of metal objects. Therefore, the nurse should be particularly concerned about pacemaker insertion when reviewing the client's medical history prior to an MRI.

4. After delegating to an unlicensed assistive personnel (UAP) the task of completing a bladder scan examination for a client, the nurse evaluates the UAP’s performance. Which action by the UAP indicates the nurse must provide additional instructions when delegating this task?

• A. Selecting the female icon for all female clients and the male icon for all male clients
• B. Explaining to the client, 'This test measures the amount of urine in your bladder.'
• C. Applying ultrasound gel to the scanning head and cleaning it after use
• D. Taking at least two readings using the aiming icon to position the scanning head

Correct answer: A

Rationale: The correct answer is A because the UAP should select the female icon for women who have not had a hysterectomy to allow the scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy, the UAP should choose the male icon. Choice B is incorrect as it is essential for the UAP to explain the procedure to the client to ensure understanding. Choice C is incorrect because applying ultrasound gel to the scanning head and cleaning it after use are appropriate actions. Choice D is incorrect as it is necessary for the UAP to take at least two readings using the aiming icon to position the scanning head accurately for an effective bladder scan examination.

5. Which of the following is a common cause of chronic liver disease?

• A. Alcohol abuse.
• B. Hepatitis C infection.
• C. Obesity.
• D. Smoking.

Correct answer: B

Rationale: Hepatitis C infection is a common cause of chronic liver disease due to its long-term effects on the liver. Hepatitis C can lead to liver inflammation, fibrosis, cirrhosis, and even liver cancer. Alcohol abuse can also cause liver damage, but hepatitis C infection is specifically known for its chronic impact on liver health. Obesity and smoking, while detrimental to overall health, are not typically direct causes of chronic liver disease like hepatitis C infection.

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