Nursing Elites

1. A client is newly prescribed lithium for bipolar disorder. Which finding is most important to report to the healthcare provider?

• A. A serum lithium level of 1.2 mEq/L.
• B. Fine hand tremors noted after starting the medication.
• C. A blood pressure of 110/60 mmHg.
• D. A serum sodium level of 140 mEq/L.

Correct answer: B

Rationale: The correct answer is B. Fine hand tremors noted after starting lithium are an early sign of lithium toxicity. It is crucial to report this finding to the healthcare provider promptly. Adjusting the dose or monitoring serum levels more closely may be necessary to prevent further toxicity. Choice A, a serum lithium level of 1.2 mEq/L, is within the therapeutic range (0.6-1.2 mEq/L) for treating bipolar disorder. Choice C, a blood pressure of 110/60 mmHg, and Choice D, a serum sodium level of 140 mEq/L, are within normal limits and not directly related to lithium therapy or toxicity.

2. An S3 heart sound is auscultated in a client in her third trimester of pregnancy. What intervention should the nurse take?

• A. Perform a 12-lead electrocardiogram
• B. Document in the client's record
• C. Notify the healthcare provider immediately
• D. Assess for signs of heart failure

Correct answer: B

Rationale: An S3 heart sound is often a normal finding in pregnant women due to increased blood volume and cardiac output. The nurse should document the finding as part of the routine assessment unless accompanied by other abnormal symptoms. Performing a 12-lead electrocardiogram (Choice A) is unnecessary for a normal S3 heart sound in pregnancy. Notifying the healthcare provider immediately (Choice C) is premature and may lead to unnecessary interventions. Assessing for signs of heart failure (Choice D) is not indicated as an isolated S3 heart sound is typically benign in pregnancy.

3. A client with gastroesophageal reflux disease (GERD) is prescribed omeprazole. What is the primary purpose of this medication?

• A. Coat the lining of the stomach
• B. Neutralize stomach acid
• C. Promote gastric motility
• D. Reduce gastric acid secretion

Correct answer: D

Rationale: The correct answer is D: Reduce gastric acid secretion. Omeprazole is a proton pump inhibitor that works by reducing the production of gastric acid in the stomach. This helps in managing GERD by decreasing the acidity levels in the stomach. Choice A is incorrect because omeprazole does not coat the lining of the stomach. Choice B is incorrect as omeprazole does not neutralize stomach acid but rather reduces its production. Choice C is incorrect because omeprazole does not promote gastric motility; instead, it acts on acid secretion.

4. When taking a health history, which information collected by the nurse correlates most directly to a diagnosis of chronic peripheral arterial insufficiency?

• A. Reports of leg cramping at rest
• B. Family history of heart disease
• C. Current use of beta-blockers
• D. History of intermittent claudication

Correct answer: D

Rationale: Corrected Rationale: Intermittent claudication, or pain in the legs while walking that is relieved by rest, is a classic symptom of peripheral arterial insufficiency. Other factors such as a family history or medication use may contribute to cardiovascular health, but claudication is the most specific indicator. Leg cramping at rest is more indicative of conditions like peripheral neuropathy or deep vein thrombosis. Family history of heart disease and current use of beta-blockers are relevant to overall cardiovascular health, but they are not as directly related to chronic peripheral arterial insufficiency as intermittent claudication.

5. An older adult client is admitted with pneumonia and prescribed penicillin G potassium. Which factor increases the risk of an adverse reaction?

• A. Sputum culture showing Streptococcus pneumoniae.
• B. Previous treatment with penicillin.
• C. Daily use of spironolactone for hypertension.
• D. Documented allergy to sulfa drugs.

Correct answer: C

Rationale: The correct answer is C. Daily use of spironolactone for hypertension can increase the risk of hyperkalemia and interact with penicillin, leading to adverse reactions. Choice A is incorrect because the sputum culture showing Streptococcus pneumoniae is an expected finding in a patient with pneumonia and does not increase the risk of an adverse reaction to penicillin. Choice B is incorrect as previous treatment with penicillin does not necessarily increase the risk of an adverse reaction to penicillin if there was no history of allergic reactions. Choice D is also incorrect as a documented allergy to sulfa drugs does not directly increase the risk of an adverse reaction to penicillin.

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