Nursing Elites

1. 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.

2. A client admitted with left-sided heart failure presents with shortness of breath and pink frothy sputum. Which assessment finding requires immediate intervention?

• A. Decreased breath sounds bilaterally.
• B. Heart rate of 110 bpm and irregular rhythm.
• C. Pink frothy sputum and increased respiratory rate.
• D. Elevated blood pressure and shortness of breath.

Correct answer: C

Rationale: Correct Answer: Pink frothy sputum and increased respiratory rate. Pink frothy sputum is a sign of pulmonary edema, indicating fluid in the lungs, a life-threatening condition that requires immediate intervention to prevent respiratory failure. Increased respiratory rate is also concerning as it indicates the body's effort to compensate for the decreased oxygenation. Options A, B, and D are not the most critical findings in this situation. Decreased breath sounds bilaterally may indicate a pneumothorax or atelectasis, heart rate of 110 bpm and irregular rhythm can be managed with medications and further assessment, and elevated blood pressure with shortness of breath is not as urgent as pink frothy sputum and increased respiratory rate.

3. A client is scheduled for a spiral CT scan with contrast to evaluate for pulmonary embolism. Which information in the client's history requires follow-up by the nurse?

• A. Is allergic to shellfish
• B. Has a history of smoking
• C. Takes metformin for type 2 diabetes mellitus
• D. Has hypertension controlled with medication

Correct answer: A

Rationale: An allergy to shellfish often indicates an allergy to iodine, which is used in contrast dyes for CT scans. This poses a significant risk of an allergic reaction during the procedure. The nurse must ensure appropriate precautions or alternative imaging are considered. Choices B, C, and D are not directly contraindicated for a CT scan with contrast. Smoking history, metformin use, and controlled hypertension do not typically impact the safety or feasibility of the procedure.

4. A woman who is breastfeeding calls her obstetrician’s office and reports increased anxiety since the vaginal delivery of her son three weeks ago. She stopped taking her antianxiety medications but is thinking of restarting them. What response should the nurse provide?

• A. Describe the potential transmission of drugs to the infant through breast milk.
• B. Encourage her to utilize stress-relieving alternatives, such as deep breathing.
• C. Explain that anxiety is a common reaction for mothers of 3-week-old infants.
• D. Inform her that some antianxiety medications are safe to take while breastfeeding.

Correct answer: D

Rationale: The correct answer is D because some antianxiety medications are considered safe during breastfeeding. The nurse should reassure the client and encourage her to discuss options with her healthcare provider to manage anxiety safely while continuing to breastfeed. Choice A is incorrect because it focuses on the transmission of drugs rather than providing guidance on safe medication use. Choice B, while promoting stress-relieving techniques, does not address the potential need for medication. Choice C is incorrect as it minimizes the woman's reported anxiety, which may require professional intervention.

5. A client is admitted to the hospital with a diagnosis of pneumonia. The client is prescribed intravenous antibiotics and oxygen therapy. Which assessment finding indicates that the client's condition is improving?

• A. Increased white blood cell count
• B. Crackles heard on lung auscultation
• C. Productive cough with green sputum
• D. Decreased respiratory rate from 24 to 18 breaths per minute

Correct answer: D

Rationale: A decrease in respiratory rate indicates that the client's breathing is becoming more stable, which suggests an improvement in their condition. Respiratory rate is a critical indicator of respiratory status and oxygenation. Increased white blood cell count (choice A) suggests ongoing infection, crackles on lung auscultation (choice B) indicate fluid in the lungs, and productive cough with green sputum (choice C) may indicate persistent infection or airway inflammation, which do not necessarily reflect improvement in pneumonia.

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