Nursing Elites

1. When assessing a client with a small bowel obstruction, what finding should a nurse expect?

• A. Significant abdominal distention
• B. Large bowel movements
• C. High-pitched bowel sounds
• D. Copious vomiting

Correct answer: C

Rationale: High-pitched bowel sounds are often heard early in a small bowel obstruction due to increased peristalsis as the bowel tries to overcome the blockage. Choices A, B, and D are incorrect. Abdominal distention is more commonly associated with large bowel obstructions, while large bowel movements and copious vomiting are not typical findings in small bowel obstructions.

2. A nurse is planning to discharge a client who has quadriplegia to his home. The nurse suggests that the family might need respite care services. When a family member asks how respite care can help, which response should the nurse provide?

• A. Respite care provides medical support to the client.
• B. Respite care assists with financial planning for the client’s needs.
• C. Respite care provides long-term housing.
• D. Respite care allows the primary caregiver time away from day-to-day care responsibilities.

Correct answer: D

Rationale: The correct answer is D. Respite care is designed to give primary caregivers temporary relief from the responsibilities of care, allowing them to take a break. Choice A is incorrect because respite care is not primarily focused on providing medical support to the client. Choice B is incorrect as respite care does not specifically assist with financial planning for the client's needs. Choice C is incorrect as respite care does not provide long-term housing, but rather short-term relief for caregivers.

3. A client just received the first dose of lisinopril. Which of the following is an appropriate nursing intervention?

• A. Place the client on cardiac monitoring
• B. Monitor the client's oxygen saturation level
• C. Provide standby assistance when getting out of bed
• D. Encourage foods high in potassium

Correct answer: C

Rationale: The correct answer is to provide standby assistance when getting out of bed. Lisinopril can cause first-dose hypotension, leading to dizziness and increasing the risk of falls. Standby assistance helps ensure the client's safety when mobilizing. Placing the client on cardiac monitoring (choice A) is not necessary unless there are specific indications for cardiac monitoring. Monitoring oxygen saturation (choice B) is not directly related to the side effects of lisinopril. Encouraging foods high in potassium (choice D) is not the most immediate or appropriate intervention following the administration of lisinopril.

4. A nurse is reviewing discharge instructions with the parents of a newborn. Which of the following statements indicates a need for further teaching?

• A. We will place the baby on its back to sleep
• B. We will give the baby a pacifier at bedtime
• C. We will keep the baby's crib free of blankets and toys
• D. We will leave the baby's diaper off to prevent diaper rash

Correct answer: D

Rationale: The correct answer is D. Leaving the baby's diaper off to prevent diaper rash is not recommended because it increases the risk of infection. Proper diaper hygiene and frequent diaper changes are more effective in preventing diaper rash. Choices A, B, and C are correct as placing the baby on its back to sleep, giving the baby a pacifier at bedtime, and keeping the baby's crib free of blankets and toys are appropriate measures to ensure the newborn's safety and reduce the risk of Sudden Infant Death Syndrome (SIDS).

5. A healthcare provider is caring for a client prescribed amiodarone. Which of the following should the healthcare provider monitor?

• A. Liver function tests
• B. Serum potassium levels
• C. Blood pressure
• D. All of the above

Correct answer: D

Rationale: Amiodarone is known to potentially affect liver function, potassium levels, and blood pressure. Monitoring all these parameters regularly is crucial to detect any adverse effects early on. Liver function tests are necessary as amiodarone can cause hepatotoxicity. Serum potassium levels should be monitored due to the risk of hypokalemia or hyperkalemia with amiodarone use. Blood pressure monitoring is essential as amiodarone can cause hypotension or hypertension. Choosing 'All of the above' is the correct answer because all these parameters should be monitored to ensure the client's safety and well-being. Monitoring only one or two of these parameters may lead to missing important signs of adverse effects.

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