Nursing Elites

1. A male client is prescribed clozapine (Clozaril), an antipsychotic medication, for the management of schizophrenia. Which client history should the nurse report to the healthcare provider before administering the first dose of this medication?

• A. History of depression
• B. History of cardiac arrhythmia
• C. History of seizures
• D. History of diabetes mellitus

Correct answer: B

Rationale: The correct answer is B: History of cardiac arrhythmia. Clozapine can lead to severe cardiovascular problems, making it crucial to report any history of cardiac arrhythmia to the healthcare provider before administering the medication. Choices A, C, and D are less concerning in this context as they are not directly associated with potential serious complications related to clozapine use.

2. A client with acute pancreatitis is admitted with severe abdominal pain. Which assessment finding should be reported to the healthcare provider immediately?

• A. Decreased bowel sounds
• B. Increased heart rate
• C. Decreased urine output
• D. Elevated blood glucose level

Correct answer: C

Rationale: Decreased urine output is concerning in a client with acute pancreatitis as it may indicate hypovolemia or renal impairment. In acute pancreatitis, decreased urine output can signify inadequate perfusion to the kidneys, leading to renal failure. While the other options are important to monitor in a client with acute pancreatitis, decreased urine output requires immediate attention to prevent further complications.

3. A gravida 2 para 1, at 38-weeks gestation, scheduled for a repeat cesarean section in one week, is brought to the labor and delivery unit complaining of contractions every 10 minutes. While assessing the client, the client's mother enters the labor suite and says in a loud voice, 'I've had 8 children and I know she's in labor. I want her to have her cesarean section right now!' What action should the nurse take?

• A. Tell the mother to stop speaking for the client.
• B. Notify the charge nurse of the situation.
• C. Request that the mother leave the room.
• D. Request security to remove her from the room.

Correct answer: C

Rationale: In this scenario, the most appropriate action for the nurse to take is to request that the mother leave the room. This is important to maintain a calm environment and allow the healthcare team to assess and manage the situation without interference. Option A is not the best choice as it may escalate the situation. Option B, notifying the charge nurse, could be considered after addressing the immediate need to remove the mother from the room. Option D, requesting security to remove her, is not necessary at this point and may further escalate the situation unnecessarily.

4. A client presents to the labor and delivery unit, screaming 'THE BABY IS COMING.' Which action should the nurse implement first?

• A. Observe the perineum
• B. Prepare the delivery room
• C. Call the obstetrician
• D. Administer pain relief

Correct answer: A

Rationale: Observing the perineum is the priority action for the nurse in this situation. It allows the nurse to assess the stage of labor, determine the urgency of the situation, and provide immediate assistance if the baby is indeed about to be delivered. Preparing the delivery room and calling the obstetrician can follow once the nurse has assessed the situation. Administering pain relief may not be the immediate priority when the baby is coming.

5. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which clinical finding requires immediate intervention?

• A. Oxygen saturation of 90%
• B. Respiratory rate of 24 breaths per minute
• C. Use of accessory muscles
• D. Inspiratory crackles

Correct answer: C

Rationale: The correct answer is C: Use of accessory muscles. In a client with COPD receiving supplemental oxygen, the use of accessory muscles is a critical finding that requires immediate intervention. This observation indicates increased work of breathing, suggesting respiratory distress. Addressing this issue promptly is crucial to prevent further respiratory compromise. Choice A, oxygen saturation of 90%, is slightly below the normal range but may not require immediate intervention unless it continues to decrease. Choice B, a respiratory rate of 24 breaths per minute, is within normal limits for an adult and does not indicate an urgent issue. Choice D, inspiratory crackles, may be present in COPD due to secretions or inflammation but do not necessitate immediate intervention unless associated with other concerning signs.

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