Nursing Elites

1. A client with a diagnosis of myocardial infarction (MI) is prescribed nitroglycerin. What is the primary action of this medication?

• A. Increases heart rate
• B. Lowers blood pressure
• C. Dilates coronary arteries
• D. Reduces myocardial oxygen demand

Correct answer: C

Rationale: The correct answer is C: Nitroglycerin dilates coronary arteries, improving blood flow to the heart muscle. This helps increase oxygen supply to the heart tissue. Option A, 'Increases heart rate,' is incorrect because nitroglycerin does not directly affect heart rate. Option B, 'Lowers blood pressure,' is also incorrect as while nitroglycerin can lower blood pressure, its primary action in the context of MI is related to coronary artery dilation. Option D, 'Reduces myocardial oxygen demand,' is not the primary action of nitroglycerin in the treatment of myocardial infarction; its main action is to increase oxygen supply by dilating coronary arteries.

2. The nurse is caring for a client with a history of seizure disorder who is receiving phenytoin (Dilantin). Which laboratory value is most important to monitor?

• A. Phenytoin level
• B. Sodium level
• C. Hemoglobin level
• D. White blood cell count

Correct answer: A

Rationale: Corrected Rationale: Monitoring the phenytoin level is crucial to ensure it is within the therapeutic range and to prevent toxicity. Monitoring sodium level is important in clients receiving lithium, not phenytoin. Hemoglobin level and white blood cell count are not directly related to phenytoin therapy monitoring.

3. A 9-year-old is receiving vancomycin 400 mg IV every 6 hours for a methicillin-resistant (Beta-lactam-resistant) Staphylococci aureus (MRSA) infection. The medication is diluted in a 100 mL bag of saline with instructions to infuse over one and a half hours. How many mL/hour should the nurse program the infusion pump?

• A. 50
• B. 67
• C. 57
• D. 70

Correct answer: B

Rationale: To calculate the infusion rate for vancomycin, you need to divide the total volume by the total time of infusion. In this case, the total volume is 100 mL, and the total time is 1.5 hours. Therefore, 100 mL ÷ 1.5 hours = 67 mL/hour. This means the nurse should program the infusion pump to deliver vancomycin at a rate of 67 mL/hour. Choice A (50) is incorrect as it does not reflect the correct calculation. Choice C (57) is incorrect as it is not the accurate calculation based on the provided information. Choice D (70) is incorrect as it does not correspond to the correct infusion rate calculation.

4. A client reports feeling dizzy and light-headed when standing up. What is the nurse's best initial action?

• A. Instruct the client to sit or lie down
• B. Monitor blood pressure and pulse
• C. Administer an anti-dizziness medication
• D. Increase fluid intake

Correct answer: B

Rationale: The correct answer is B: Monitor blood pressure and pulse. When a client reports feeling dizzy and light-headed when standing up, the nurse's best initial action should be to monitor the client's blood pressure and pulse. These symptoms are indicative of orthostatic hypotension, which can be confirmed by changes in blood pressure and pulse when moving from lying to standing positions. Instructing the client to sit or lie down may provide temporary relief but does not address the underlying cause. Administering an anti-dizziness medication should not be the initial action without assessing vital signs first. Increasing fluid intake is important for overall health but is not the priority in this situation where vital sign monitoring is needed to assess for orthostatic hypotension.

5. Before administration of a stat dose of potassium chloride IV for a client with hypokalemia, what is the most important action for the nurse?

• A. Ensure the IV is flowing freely
• B. Mix the medication thoroughly
• C. Check the client’s electrolyte levels
• D. Obtain a baseline ECG

Correct answer: A

Rationale: The most crucial action for the nurse before administering a stat dose of potassium chloride IV to a client with hypokalemia is to ensure the IV is flowing freely. A freely flowing IV is essential to safely and effectively deliver potassium chloride, helping to prevent infusion-related issues. Checking the client's electrolyte levels or obtaining a baseline ECG may be important but are not the most critical actions before administering the medication. Mixing the medication thoroughly is not applicable in this scenario as potassium chloride is typically provided ready to use.

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