Nursing Elites

1. The nurse plans to administer a scheduled dose of metoprolol (Toprol SR) at 0900 to a client with hypertension. At 0800, the nurse notes that the client's telemetry pattern shows a second-degree heart block with a ventricular rate of 50. What action should the nurse take?

• A. Administer the Toprol immediately and monitor the client until the heart rate increases.
• B. Provide the dose of Toprol as scheduled and assign a UAP to monitor the client's BP q30 minutes.
• C. Give the Toprol as scheduled if the client's systolic blood pressure reading is greater than 180.
• D. Hold the scheduled dose of Toprol and notify the healthcare provider of the telemetry pattern.

Correct answer: D

Rationale: In clients with second-degree heart block, beta blockers such as metoprolol (Toprol SR) are contraindicated as they can further decrease the heart rate. Administering metoprolol in this situation can lead to serious complications. The correct action for the nurse to take is to hold the scheduled dose of Toprol and promptly notify the healthcare provider of the telemetry pattern. This ensures patient safety and appropriate management of the cardiac condition. Choices A, B, and C are incorrect because administering Toprol despite the heart block can worsen the condition and pose a risk to the client's health.

2. A client with acute pancreatitis is admitted with severe abdominal pain. Which assessment finding should be reported to the healthcare provider immediately?

• A. Decreased bowel sounds
• B. Increased heart rate
• C. Decreased urine output
• D. Elevated blood glucose level

Correct answer: C

Rationale: Decreased urine output is concerning in a client with acute pancreatitis as it may indicate hypovolemia or renal impairment. In acute pancreatitis, decreased urine output can signify inadequate perfusion to the kidneys, leading to renal failure. While the other options are important to monitor in a client with acute pancreatitis, decreased urine output requires immediate attention to prevent further complications.

3. The nurse enters a client's room and observes the unlicensed assistive personnel (UAP) making an occupied bed. What action should the nurse take first?

• A. Place the side rails in an up position.
• B. Assist the UAP in turning the client.
• C. Provide instructions on proper bed-making techniques.
• D. Ask the client if they are comfortable.

Correct answer: A

Rationale: The correct answer is to place the side rails in an up position first. This action is essential to prevent the client from falling while the bed is being made. Assisting the UAP in turning the client (Choice B) is not the immediate priority. Providing instructions on bed-making techniques (Choice C) can wait until the safety of the client is ensured. Asking the client if they are comfortable (Choice D) is important but should come after ensuring the client's safety by raising the side rails.

4. After checking the fingerstick glucose at 1630, what action should be implemented?

• A. Notify the healthcare provider.
• B. Administer 8 units of insulin aspart SubQ.
• C. Give an IV bolus of Dextrose 50% 50 ml.
• D. Perform quality control on the glucometer.

Correct answer: B

Rationale: Administering insulin aspart (rapid-acting insulin) is the appropriate action to manage the elevated glucose level of 1630. Choice A, notifying the healthcare provider, is not the immediate action needed for this glucose level. Choice C, giving an IV bolus of Dextrose 50%, would exacerbate hyperglycemia instead of treating it. Choice D, performing quality control on the glucometer, is not relevant to the management of the patient's glucose level at this time.

5. The healthcare provider is assessing a client with left-sided heart failure. Which laboratory value should be monitored closely?

• A. Serum sodium of 135 mEq/L
• B. Serum potassium of 4.5 mEq/L
• C. Serum creatinine of 1.8 mg/dl
• D. Serum glucose of 200 mg/dl

Correct answer: C

Rationale: In a client with left-sided heart failure, monitoring serum creatinine is crucial to evaluate kidney function and fluid balance. Elevated creatinine levels can indicate impaired kidney function, which is common in heart failure due to decreased cardiac output and renal perfusion. Serum sodium levels (choice A) are important but are more closely associated with fluid balance and heart failure exacerbation. Serum potassium (choice B) is also important to monitor, but it is more closely linked to cardiac arrhythmias rather than kidney function. Serum glucose levels (choice D) are significant but are not the priority for monitoring in left-sided heart failure.

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