Nursing Elites

1. A client with a history of heart failure is admitted with a diagnosis of pulmonary edema. Which intervention should the LPN/LVN expect to assist with first?

• A. Administer a diuretic as prescribed.
• B. Place the client in a high Fowler's position.
• C. Prepare the client for intubation.
• D. Insert an indwelling urinary catheter.

Correct answer: B

Rationale: In a client with pulmonary edema, placing them in a high Fowler's position is the priority intervention. This position helps to improve ventilation and oxygenation by decreasing venous return, reducing the workload on the heart, and facilitating fluid redistribution from the lungs. It is crucial to optimize respiratory function and oxygenation before considering other interventions like administering medications, preparing for intubation, or inserting a urinary catheter. Administering a diuretic, preparing for intubation, or inserting a urinary catheter may be necessary but should follow the priority of improving oxygenation through positioning.

2. The nurse is assisting in the care of a client with a history of chronic obstructive pulmonary disease (COPD) who is on oxygen therapy. Which action should the nurse take to ensure the client's safety?

• A. Set the oxygen flow rate to 4 liters per minute.
• B. Remove oxygen while the client is eating.
• C. Ensure the client wears a nasal cannula instead of a face mask.
• D. Maintain the oxygen flow rate at the lowest level that relieves hypoxia.

Correct answer: D

Rationale: For clients with COPD, too much oxygen can suppress their drive to breathe, leading to hypoventilation. Therefore, the nurse should maintain the oxygen flow rate at the lowest level that relieves hypoxia to prevent complications while ensuring adequate oxygenation. Setting the oxygen flow rate too high (Choice A) can be detrimental for the client with COPD. Removing oxygen while the client is eating (Choice B) can compromise oxygenation, which is essential even during meals. While nasal cannulas are commonly used, the choice of oxygen delivery device depends on the client's needs; there may be situations where a face mask (Choice C) is more appropriate.

3. The client has atrial fibrillation and is receiving warfarin (Coumadin) therapy. Which laboratory test should be monitored to evaluate the effectiveness of the warfarin therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Complete blood count (CBC)
• D. Fibrinogen levels

Correct answer: A

Rationale: Monitoring the Prothrombin time (PT) and international normalized ratio (INR) is crucial for assessing the effectiveness of warfarin therapy. These tests help determine the clotting ability of the blood and ensure that the client is within the desired therapeutic range to prevent clotting events or bleeding complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy, not warfarin. Complete blood count (CBC) (Choice C) and fibrinogen levels (Choice D) do not directly assess the effectiveness of warfarin therapy in the same way that PT and INR do.

4. The client with a history of angina pectoris reports chest pain unrelieved by nitroglycerin. Which action should the nurse take next?

• A. Administer another dose of nitroglycerin.
• B. Notify the healthcare provider immediately.
• C. Have the client lie down and rest.
• D. Encourage the client to take deep breaths.

Correct answer: B

Rationale: When a client with a history of angina pectoris reports chest pain unrelieved by nitroglycerin, it may indicate a myocardial infarction, also known as a heart attack. In this situation, the nurse should immediately notify the healthcare provider to ensure prompt evaluation and appropriate intervention. Delay in seeking medical attention for chest pain unrelieved by nitroglycerin can be life-threatening, as it might be a sign of a more serious cardiac event. Administering another dose of nitroglycerin (Choice A) without further evaluation can be risky, as the client's condition may require a different intervention. Having the client lie down and rest (Choice C) or encouraging deep breaths (Choice D) are not appropriate actions in this scenario where a more serious cardiac event needs to be ruled out.

5. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed?

• A. Strict bed rest for 24 hours
• B. Bathroom privileges and self-care activities
• C. Unrestricted activities because the client is monitored
• D. Unsupervised hallway ambulation with distances less than 200 feet

Correct answer: B

Rationale: After being transferred from the CCU to the general medical unit with cardiac monitoring, the client with MI is typically prescribed bathroom privileges and self-care activities. This approach allows for gradual recovery and mobility while still being closely monitored, promoting the client's overall well-being and independence. Choice A, strict bed rest for 24 hours, is too restrictive and not recommended for MI patients as it can lead to complications like deep vein thrombosis. Choice C, unrestricted activities, is also not appropriate as MI patients usually require monitoring and gradual re-introduction to activities. Choice D, unsupervised hallway ambulation with distances less than 200 feet, may be too strenuous for a client who just got transferred from the CCU and needs a more gradual approach to activity.

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