Nursing Elites

1. A client presents to the emergency department with complaints of chest pain and shortness of breath. The client's ECG shows ST-segment elevation. What is the priority nursing intervention?

• A. Administer aspirin as prescribed.
• B. Prepare the client for emergent coronary angiography.
• C. Administer oxygen therapy.
• D. Initiate CPR.

Correct answer: B

Rationale: In a client presenting with chest pain, shortness of breath, and ST-segment elevation on ECG, the priority nursing intervention is to prepare the client for emergent coronary angiography. This procedure is crucial in diagnosing and treating acute myocardial infarction promptly. Administering aspirin (Choice A) is important but not the priority over emergent coronary angiography. Administering oxygen therapy (Choice C) is supportive but does not address the underlying cause of the ST-segment elevation. Initiating CPR (Choice D) is not the priority in this scenario as the client is stable and conscious.

2. The nurse is preparing to administer a vaccine to a newborn. Before administering the vaccine, the nurse should

• A. warm the vaccine to room temperature.
• B. gently cleanse the chosen injection site.
• C. check the infant's temperature.
• D. administer the full dose at a single injection site.

Correct answer: C

Rationale: Before administering a vaccine to a newborn, it is essential for the nurse to check the infant's temperature. This is important to ensure that the newborn does not have a fever, which could indicate an underlying infection or illness. Warming the vaccine to room temperature is not necessary and could be harmful. Vigorously massaging the injection site is not recommended as it can cause discomfort and tissue damage. Dividing the dose for administration to three injection sites is not standard practice for vaccine administration to a newborn.

3. A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?

• A. Bronze-colored skin
• B. Decreased iron
• C. Normochromic erythrocytes
• D. Aplastic bone marrow

Correct answer: A

Rationale: The correct answer is A: 'Bronze-colored skin.' Sideroblastic anemia is characterized by excess iron deposition, leading to bronze-colored skin. This occurs due to the abnormal accumulation of iron in tissues. Choices B, C, and D are incorrect because sideroblastic anemia does not typically present with decreased iron levels, normochromic erythrocytes, or aplastic bone marrow.

4. A patient who is taking metronidazole for the past 4 days for the treatment of a parasitic infection reports to the nurse that his most recent dose made him 'flushed, sweaty, and sick in the stomach.' What assessment is most likely to address the cause of this phenomenon?

• A. “Have you experienced any allergic reactions to metronidazole before?”
• B. “Did you drink any alcoholic beverages around the time of taking the drug?”
• C. “Did you take this dose on an empty stomach?”
• D. “Are you currently using any over-the-counter antihistamines?”

Correct answer: B

Rationale: The correct answer is B. Metronidazole can cause a disulfiram-like reaction when taken with alcohol, leading to symptoms such as flushing, sweating, and gastrointestinal upset. Asking the patient about alcohol consumption can help identify if this reaction is due to alcohol interaction. Choice A is incorrect as it focuses on penicillin allergy, which is not relevant to metronidazole. Choice C is less likely to cause the reported symptoms and is not a common concern with metronidazole. Choice D is not directly related to the symptoms described by the patient.

5. When a healthcare professional notices that a patient has type O blood, they realize that anti-_____ antibodies are present in the patient's body.

• A. A only
• B. B only
• C. A and B
• D. O

Correct answer: C

Rationale: Individuals with type O blood have both anti-A and anti-B antibodies in their body. This is because type O blood lacks A or B antigens on the surface of red blood cells, causing the body to produce antibodies against both A and B antigens. Therefore, the correct answer is C. Choice A and B only antibodies are incorrect because type O individuals have both anti-A and anti-B antibodies. Choice D is incorrect as O represents the blood type itself, not the antibodies present in the blood.

Similar Questions