Nursing Elites

1. While assessing a client who is admitted with heart failure and pulmonary edema, the nurse identifies dependent peripheral edema, an irregular heart rate, and a persistent cough that produces pink blood-tinged sputum. After initiating continuous telemetry and positioning the client, which intervention should the nurse implement?

• A. Administer prescribed diuretics
• B. Prepare for intubation
• C. Notify the healthcare provider immediately
• D. Obtain sputum sample

Correct answer: D

Rationale: The client's cough producing pink, frothy sputum is indicative of pulmonary edema, which needs immediate treatment. Obtaining a sputum sample helps identify any infection that may be contributing to the pulmonary issues. Administering diuretics is essential in managing pulmonary edema but obtaining a sputum sample should take priority. Intubation may be necessary in severe cases but is not the initial intervention. Notifying the healthcare provider is important, but immediate action to diagnose and treat the condition is crucial.

2. A nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse?

• A. A client with a Dopamine drip IV with vital signs monitored every 5 minutes
• B. A client with a myocardial infarction that is free from pain and dysrhythmias
• C. A client with a tracheotomy of 24 hours in some respiratory distress
• D. A client with a pacemaker inserted this morning with intermittent capture

Correct answer: B

Rationale: In this scenario, it is more appropriate to assign a stable client, such as the one with a myocardial infarction who is free from pain and dysrhythmias, to a nurse who lacks specialized critical care experience. This client's condition is relatively stable and does not require immediate critical interventions. Choices A, C, and D involve clients with more complex and critical conditions that would be better managed by a nurse with specialized critical care training. Choice A involves a client on a Dopamine drip with frequent vital sign monitoring, Choice C has a client with a tracheotomy in respiratory distress, and Choice D describes a client with a pacemaker experiencing intermittent capture, all of which require a higher level of critical care expertise.

3. The nurse is caring for a client with chronic heart failure who is receiving digoxin therapy. The nurse reviews the client's lab results and notes that the serum potassium level is 3.0 mEq/L. What action should the nurse take next?

• A. Administer a potassium supplement
• B. Notify the healthcare provider
• C. Hold the next dose of digoxin
• D. Increase dietary potassium intake

Correct answer: C

Rationale: In clients receiving digoxin therapy, low potassium levels can increase the risk of digoxin toxicity. Therefore, when the nurse notes a serum potassium level of 3.0 mEq/L, it is crucial to hold the next dose of digoxin. Notifying the healthcare provider is essential to ensure appropriate interventions, such as potassium supplementation, can be implemented. Administering a potassium supplement without healthcare provider guidance may lead to rapid potassium level changes and potential adverse effects. Increasing dietary potassium intake alone may not promptly address the low serum potassium level in this acute situation.

4. An older client with chronic emphysema is admitted to the emergency room with acute weakness, palpitations, and vomiting. Which information is most important for the nurse to obtain during the initial interview?

• A. Recent compliance with prescribed medications.
• B. Sleep patterns during the previous few weeks.
• C. History of smoking over the past 6 months.
• D. Activity level prior to the onset of symptoms.

Correct answer: A

Rationale: The correct answer is A. In this scenario, the most critical information for the nurse to obtain during the initial interview is the recent compliance with prescribed medications. This is crucial to understand the client's baseline condition and management of chronic emphysema. Monitoring medication adherence can provide insights into potential exacerbating factors that may have led to the current acute symptoms. Choices B, C, and D are not as crucial in this situation. Sleep patterns, smoking history, and activity levels are important aspects of the client's overall health but do not take precedence over medication compliance when addressing acute symptoms in a client with chronic emphysema.

5. A client who had a subtotal parathyroidectomy two days ago is now preparing for discharge. Which assessment finding requires immediate provider notification?

• A. Afebrile with a normal pulse.
• B. No bowel movement since surgery.
• C. No appetite for breakfast.
• D. A positive Chvostek's sign.

Correct answer: D

Rationale: A positive Chvostek's sign suggests hypocalcemia, which is a post-parathyroidectomy complication and requires prompt treatment. The other options are less urgent: being afebrile with a normal pulse is expected, no bowel movement since surgery can be managed with interventions like early ambulation and stool softeners, and no appetite for breakfast is common postoperatively and can be addressed without immediate provider notification.

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