Nursing Elites

1. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide?

• A. Abruptly stop the medication.
• B. Continue the medication at the same dose.
• C. Ask the healthcare provider about tapering the drug dose over the next week.
• D. Increase the dose of the medication.

Correct answer: C

Rationale: Gradually tapering the dose over one to two weeks should be recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias.

2. The client with liver cirrhosis needs immediate intervention for which abnormal laboratory result?

• A. Prothrombin time (PT) of 14 seconds.
• B. Bilirubin of 1.2 mg/dL.
• C. Albumin of 4 g/dL.
• D. Ammonia level of 80 mcg/dL.

Correct answer: D

Rationale: An elevated ammonia level of 80 mcg/dL indicates hepatic encephalopathy, a serious complication of liver cirrhosis that requires immediate intervention. Ammonia is a neurotoxin that accumulates in the blood due to impaired liver function, leading to cognitive impairment and altered mental status. Monitoring and lowering ammonia levels are crucial in managing hepatic encephalopathy to prevent further neurological deterioration. Prothrombin time, bilirubin, and albumin levels are important parameters in assessing liver function and overall health status in clients with liver cirrhosis, but an elevated ammonia level poses an immediate threat to neurological function and warrants prompt attention.

3. A public health nurse is working with a community to improve vaccination rates. Which intervention is most likely to be effective?

• A. Setting up vaccination clinics in accessible locations
• B. Distributing flyers with information about vaccines
• C. Offering incentives for getting vaccinated
• D. Partnering with local businesses to promote vaccination

Correct answer: A

Rationale: Setting up vaccination clinics in accessible locations is the most effective intervention to improve vaccination rates. This intervention ensures easy access to vaccination services for community members, removing barriers such as transportation or time constraints. Distributing flyers (Choice B) may increase awareness but may not directly address access issues. Offering incentives (Choice C) might temporarily boost vaccination rates but may not lead to sustained behavior change. Partnering with local businesses (Choice D) could be beneficial for promotion but may not directly impact vaccination accessibility.

4. When developing a program to support caregivers of elderly patients, which topic should be prioritized in the first session?

• A. Managing medication schedules
• B. Recognizing signs of caregiver burnout
• C. Effective communication with healthcare providers
• D. Navigating insurance and financial issues

Correct answer: B

Rationale: Recognizing signs of caregiver burnout is the most critical topic to prioritize in the first session. Caregiver burnout can have detrimental effects on both the caregiver and the elderly patient's well-being. By addressing this issue early on, caregivers can learn to identify the signs of burnout, take necessary steps to prevent it, and ensure they can continue providing effective care for their loved ones. Managing medication schedules, effective communication with healthcare providers, and navigating insurance and financial issues are also important aspects to cover in the program. However, recognizing signs of caregiver burnout is essential for the overall health and quality of care provided by the caregivers.

5. A client with a history of coronary artery disease is admitted with chest pain. Which assessment finding requires immediate intervention?

• A. Heart rate of 90 beats per minute.
• B. Respiratory rate of 20 breaths per minute.
• C. Blood pressure of 130/80 mm Hg.
• D. Chest pain radiating to the left arm.

Correct answer: D

Rationale: Chest pain radiating to the left arm is a classic symptom of a myocardial infarction (heart attack) in individuals with coronary artery disease. This finding indicates that the heart muscle may not be receiving adequate oxygen, which requires immediate intervention to prevent further damage or complications. The other assessment findings (heart rate of 90 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 130/80 mm Hg) are within normal limits and do not suggest an acute, life-threatening condition like myocardial infarction.

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