Nursing Elites

1. A client with heart disease is on a continuous telemetry monitor and has developed sinus bradycardia. In determining the possible cause of the bradycardia, the nurse assesses the client's medication record. Which medication is most likely the cause of the bradycardia?

• A. Propranolol (Inderal).
• B. Captopril (Capoten).
• C. Furosemide (Lasix).
• D. Dobutamine (Dobutrex).

Correct answer: A

Rationale: Propranolol (Inderal) is a beta-adrenergic blocking agent that acts to decrease heart rate and contractility. Sinus bradycardia is a common side effect of beta blockers due to their negative chronotropic effect on the heart. Captopril (Capoten) is an ACE inhibitor used for hypertension and heart failure, not associated with causing bradycardia. Furosemide (Lasix) is a loop diuretic that can lead to electrolyte imbalances but not commonly linked to bradycardia. Dobutamine (Dobutrex) is a beta-1 adrenergic agonist that increases heart rate and contractility, making it an unlikely cause of bradycardia in this scenario.

2. A client is getting out of bed for the first time since surgery. The client complains of dizziness after the nurse raises the head of the bed. Which of the following actions should the nurse take first?

• A. Checking the client’s blood pressure
• B. Checking the oxygen saturation level
• C. Having the client take some deep breaths
• D. Lowering the head of the bed slowly until the dizziness is relieved

Correct answer: D

Rationale: When a client experiences dizziness after being positioned upright for the first time post-surgery, the initial action the nurse should take is to lower the head of the bed slowly until the dizziness subsides. This maneuver helps alleviate the dizziness by allowing the body to adapt gradually to the change in position. Subsequently, the nurse should assess the client's pulse and blood pressure. Checking the blood pressure is essential to evaluate the circulatory status and rule out orthostatic hypotension as a cause of dizziness. Checking the oxygen saturation level and having the client take deep breaths are not the priority in this scenario as the primary concern is addressing the circulatory issue causing dizziness, not a respiratory problem.

3. A client with a history of peptic ulcer disease (PUD) is admitted after vomiting bright red blood several times over the course of 2 hours. In reviewing the laboratory results, the nurse finds the client's hemoglobin is 12 g/dL (120g/L) and the hematocrit is 35% (0.35). Which action should the nurse prepare to take?

• A. Continue monitoring for blood loss
• B. Administer 1,000 mL (1L) of normal saline
• C. Transfuse 2 units of platelets
• D. Prepare the client for emergency surgery

Correct answer: D

Rationale: The correct answer is to prepare the client for emergency surgery. The client's presentation with bright red blood in vomitus suggests active bleeding, which is a medical emergency. With a hemoglobin of 12 g/dL and a hematocrit of 35%, the client is likely experiencing significant blood loss that may require surgical intervention to address the source of bleeding. Continuing to monitor for blood loss (Choice A) is not appropriate in this acute situation where immediate action is necessary. Administering normal saline (Choice B) may help with fluid resuscitation but does not address the underlying cause of bleeding. Transfusing platelets (Choice C) is not indicated in this scenario as platelets are involved in clot formation and are not the primary treatment for active bleeding in this context.

4. Which of the following interventions is most appropriate for a patient with acute pancreatitis?

• A. Administering oral fluids.
• B. Administering IV fluids.
• C. Administering analgesics.
• D. Encouraging the patient to ambulate.

Correct answer: B

Rationale: The most appropriate intervention for a patient with acute pancreatitis is administering IV fluids. IV fluid administration is crucial in managing acute pancreatitis as it helps maintain hydration, correct electrolyte imbalances, and prevent shock. Administering oral fluids (Choice A) may not be sufficient to address the fluid loss and maintain hydration in these patients. While analgesics (Choice C) are important for pain management in pancreatitis, addressing hydration and shock prevention takes precedence. Encouraging the patient to ambulate (Choice D) may be beneficial in some cases for preventing complications like deep vein thrombosis, but it is not the primary intervention needed in the acute phase of pancreatitis.

5. A client who has heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which action is most important for the nurse to implement?

• A. Administer 20 mEq of potassium chloride.
• B. Initiate continuous cardiac monitoring.
• C. Arrange a consultation with the dietitian.
• D. Educate about the side effects of diuretics.

Correct answer: B

Rationale: Hypokalemia, defined as a serum potassium level below the normal range of 3.5 to 5 mEq/L, can lead to changes in myocardial irritability and ECG waveform, potentially causing life-threatening dysrhythmias. Therefore, the priority action for the nurse is to initiate continuous cardiac monitoring to promptly detect any abnormal heart rhythms or ventricular ectopy. This monitoring is crucial for assessing the impact of potassium replacement therapy on the cardiac rhythm and ensuring the safety of the client. While administering potassium chloride is important for correcting the hypokalemia, it should occur after cardiac monitoring is in place. Consulting with a dietitian and educating about diuretic side effects are relevant aspects of care but are not the immediate priority in this situation where cardiac monitoring takes precedence for timely intervention.

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