Nursing Elites

1. A client with Cushing's syndrome presents with excessive bruising and elevated blood glucose. What action should the nurse take first?

• A. Check the client's blood glucose level.
• B. Administer insulin per sliding scale protocol.
• C. Administer intravenous fluids.
• D. Check the client's skin for signs of bruising.

Correct answer: A

Rationale: Excessive bruising and elevated blood glucose are common symptoms of Cushing's syndrome. The nurse should first check the client's blood glucose level to assess and address the hyperglycemia promptly. Administering insulin or IV fluids would be premature without knowing the current blood glucose level. Checking the skin for bruising, although important for overall assessment, does not address the immediate concern of elevated blood glucose.

2. A client is admitted with a large bowel obstruction. What finding should the nurse report immediately?

• A. Absence of bowel sounds in all four quadrants.
• B. Abdominal distention with a firm, rigid abdomen.
• C. Frequent, small, liquid stools.
• D. Nausea and vomiting that worsens after meals.

Correct answer: B

Rationale: Abdominal distention with a firm, rigid abdomen is a concerning sign that may indicate perforation, which requires immediate intervention. The rigidity suggests a complication of the large bowel obstruction. Absence of bowel sounds in all four quadrants, option A, is a common finding in a bowel obstruction but not as alarming as a rigid abdomen. Frequent, small, liquid stools, option C, are not typical findings in a large bowel obstruction; instead, constipation is more common. Nausea and vomiting that worsens after meals, option D, are also common symptoms of a bowel obstruction but do not indicate an immediate life-threatening complication like a perforation.

3. A client with a history of atrial fibrillation is prescribed warfarin. What is the nurse's priority teaching?

• A. Avoid eating foods high in potassium.
• B. Avoid foods high in vitamin K.
• C. Take the medication on an empty stomach.
• D. Take the medication at bedtime for best results.

Correct answer: B

Rationale: The correct answer is B: 'Avoid foods high in vitamin K.' Warfarin is an anticoagulant medication that works by interfering with vitamin K-dependent clotting factors. Therefore, consuming foods high in vitamin K can affect the medication's effectiveness. Choices A, C, and D are incorrect because: A) Warfarin is not affected by foods high in potassium; C) Warfarin should be taken with food to minimize gastrointestinal side effects; D) There is no specific requirement for taking warfarin at bedtime for best results.

4. A nurse finds a pregnant client at 33 weeks gestation in cardiac arrest. What modification to cardiopulmonary resuscitation (CPR) should the nurse implement?

• A. Administer chest compressions at a faster rate.
• B. Position a firm wedge under the client’s pelvis and thorax at a 30-degree tilt.
• C. Position the client flat with legs elevated.
• D. Call for immediate assistance and prepare for a cesarean section.

Correct answer: B

Rationale: In a pregnant client at 33 weeks gestation, performing CPR requires tilting the pelvis and thorax at a 30-degree angle to relieve pressure on the vena cava, ensuring proper circulation during compressions. Administering chest compressions at a faster rate (Choice A) may not address the specific needs of a pregnant client in cardiac arrest. Positioning the client flat with legs elevated (Choice C) is not recommended as it can worsen vena cava compression. Calling for immediate assistance and preparing for a cesarean section (Choice D) should be considered only after initiating appropriate CPR modifications.

5. A client with deep vein thrombosis (DVT) is prescribed warfarin. What lab value should the nurse review before administering the medication?

• A. Prothrombin time (PT)
• B. Hemoglobin and hematocrit (H&H)
• C. International Normalized Ratio (INR)
• D. Partial thromboplastin time (PTT)

Correct answer: C

Rationale: The correct answer is C: International Normalized Ratio (INR). Before administering warfarin to a client with deep vein thrombosis, the nurse should review the INR to ensure the client is within the therapeutic range. INR is specifically monitored for patients on warfarin therapy to assess the clotting ability of the blood. Choices A, B, and D are incorrect as they are not the primary lab value used to monitor warfarin therapy. Prothrombin time (PT) is used to measure how long blood takes to clot. Hemoglobin and hematocrit (H&H) assess for anemia and the blood's oxygen-carrying capacity. Partial thromboplastin time (PTT) is used to monitor heparin therapy, not warfarin.

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