Nursing Elites

1. A nurse is caring for a client prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about?

• A. Potassium supplements
• B. Ciprofloxacin
• C. Escitalopram
• D. Magnesium supplements

Correct answer: A

Rationale: The correct answer is A: Potassium supplements. Lisinopril, an ACE inhibitor, can increase potassium levels in the body. Therefore, the nurse should instruct the client to avoid potassium supplements to prevent hyperkalemia, a potentially dangerous condition. Choices B, C, and D are incorrect because they do not have significant interactions with lisinopril that would lead to adverse effects like hyperkalemia.

2. A client is to undergo a liver biopsy. Which of the following instructions should the nurse provide to the client following the procedure?

• A. “Lie on your left side.”
• B. “Lie on your right side.”
• C. “Increase your fluid intake.”
• D. “Decrease your fluid intake.”

Correct answer: B

Rationale: Following a liver biopsy, the nurse should instruct the client to lie on the right side to promote hemostasis. This position helps apply pressure to the biopsy site, reducing the risk of bleeding. Instructing the client to lie on the left side (Choice A) would not provide the same benefit. Increasing fluid intake (Choice C) is generally beneficial post-procedure to prevent dehydration and promote healing. Decreasing fluid intake (Choice D) is not advisable as it can lead to dehydration and potential complications.

3. A nurse is assessing a newborn whose mother had gestational diabetes. Which of the following findings should the nurse identify as a manifestation of hypoglycemia?

• A. Hypertonia
• B. Jitteriness
• C. Acrocyanosis
• D. Generalized petechiae

Correct answer: B

Rationale: Jitteriness is a common sign of hypoglycemia in newborns. Other signs may include irritability, poor feeding, and lethargy. Choice A, Hypertonia, is not typically associated with hypoglycemia but rather with conditions like hypocalcemia. Acrocyanosis (Choice C) is a benign condition characterized by peripheral cyanosis and is not directly linked to hypoglycemia. Generalized petechiae (Choice D) are tiny red or purple spots on the skin due to bleeding and are not specific to hypoglycemia.

4. Which of the following characteristics would indicate true labor in a client?

• A. Contractions are irregular and painless
• B. Fetus moves to an anterior position
• C. Bloody show is not present
• D. Contractions are regular in frequency

Correct answer: D

Rationale: The correct answer is D. True labor is characterized by regular contractions that increase in intensity and frequency. These contractions lead to cervical dilation and effacement, signaling the onset of labor. Choice A is incorrect because true labor contractions are regular and painful, not irregular and painless. Choice B is irrelevant to determining true labor. Choice C is also unrelated as the presence or absence of a bloody show does not definitively indicate true labor.

5. A client is in the transition phase of labor. Which of the following actions should the nurse take?

• A. Assist the client to void every 3 hours
• B. Monitor contractions every 30 minutes
• C. Place the client in a lithotomy position
• D. Encourage the client to use a pant-blow breathing pattern

Correct answer: D

Rationale: Encouraging the client to use a pant-blow breathing pattern is crucial during the transition phase of labor. This phase is characterized by intense contractions and emotional responses. Pant-blow breathing helps manage pain and anxiety, providing comfort and support to the client. Voiding every 3 hours is not specific to the transition phase and may not address immediate needs. Monitoring contractions every 30 minutes is important but may not be as directly beneficial as focusing on coping mechanisms like breathing techniques. Placing the client in a lithotomy position is generally not recommended during the transition phase as it can impede progress and comfort.

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