Nursing Elites

1. A client with newly diagnosed hypertension is prescribed enalapril (Vasotec). Which instruction should the nurse provide to the client?

• A. Increase your intake of potassium-rich foods.
• B. Report any persistent cough to your healthcare provider.
• C. Take the medication with a full meal.
• D. Avoid grapefruit juice while taking this medication.

Correct answer: B

Rationale: The correct instruction for the nurse to provide the client taking enalapril (Vasotec) is to report any persistent cough to their healthcare provider. Enalapril can cause a side effect of a persistent cough, and it is essential for the healthcare provider to be notified if this occurs to evaluate the need for a medication adjustment or change. Choices A, C, and D are incorrect. Increasing potassium-rich foods is not specifically related to enalapril use; there is no requirement to take enalapril with a full meal, and avoiding grapefruit juice is more relevant for medications metabolized by the CYP3A4 enzyme, not typically for enalapril.

2. A 38-year-old male client collapsed at his outside construction job in Texas in July. His admitting vital signs to ICU are, BP 82/70, heart rate 140 beats/minute, urine output 10 ml/hr, skin cool to the touch. Pulmonary artery (PA) pressures are, PAWP 1, PAP 8/2, RAP -1, SVR 1600. What nursing action has the highest priority?

• A. Apply a hypothermia unit to stabilize core temperature.
• B. Increase the client's IV fluid rate to 200 ml/hr.
• C. Call the hospital chaplain to counsel the family.
• D. Draw blood cultures x3 to detect infection.

Correct answer: B

Rationale: The correct answer is to increase the client's IV fluid rate to 200 ml/hr. The client's vital signs indicate signs of shock and hypovolemia, making fluid resuscitation the priority to address these conditions. Improving intravascular volume is crucial to stabilize the client's blood pressure, heart rate, and urine output, ultimately improving organ perfusion and addressing the underlying issue of hypovolemia.

3. A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Diverticulitis

Correct answer: A

Rationale: The constellation of symptoms including abdominal pain, diarrhea, and rectal bleeding in a young woman with a history of similar episodes is highly suggestive of ulcerative colitis. This chronic inflammatory condition primarily affects the colon and rectum, leading to symptoms such as bloody diarrhea, abdominal pain, and urgency. The recurrent nature of her symptoms and the presence of rectal bleeding further support this diagnosis over other conditions listed, such as irritable bowel syndrome, celiac disease, or diverticulitis, which typically do not present with the same combination of symptoms and history.

4. The client is prescribed clozapine (Clozaril), and the nurse plans to educate them about its purpose. Which statement should the nurse provide?

• A. It will help you function better in the community.
• B. The medication will help you think more clearly.
• C. You will be able to cope with your symptoms.
• D. It will improve your grooming and hygiene.

Correct answer: B

Rationale: Clozapine (Clozaril) is an antipsychotic medication that is known to improve cognitive function and thought clarity in individuals with schizophrenia. It primarily helps in managing symptoms related to thought processes rather than focusing on community function, coping with symptoms, or grooming and hygiene.

5. A client with heart failure is prescribed digoxin (Lanoxin). Which instruction should the nurse include in the client's teaching plan?

• A. Take your pulse before each dose and hold the medication if your pulse is below 60 beats per minute.
• B. Increase your intake of foods high in potassium.
• C. Take the medication with a high-fiber meal to enhance absorption.
• D. Skip a dose if you feel dizzy or lightheaded.

Correct answer: A

Rationale: The correct instruction for a client prescribed digoxin is to take their pulse before each dose and hold the medication if the pulse is below 60 beats per minute. This is crucial to prevent digoxin toxicity, as digoxin can cause adverse effects when the pulse rate is too low. Monitoring the pulse regularly ensures safety and appropriate management of the medication.

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