Nursing Elites

1. A nurse is caring for a client who has a history of alcohol use disorder and is experiencing withdrawal. Which of the following actions should the nurse take?

• A. Administer naloxone
• B. Administer diazepam
• C. Encourage oral fluid intake
• D. Administer magnesium sulfate

Correct answer: B

Rationale: The correct action for the nurse to take when caring for a client with alcohol use disorder experiencing withdrawal is to administer diazepam. Diazepam is a benzodiazepine commonly used to manage withdrawal symptoms in these clients by reducing anxiety, tremors, and the risk of seizures. Administering naloxone (Choice A) is used for opioid overdose, not alcohol withdrawal. Encouraging oral fluid intake (Choice C) is generally beneficial but not a specific intervention for alcohol withdrawal. Administering magnesium sulfate (Choice D) is not indicated for alcohol withdrawal but may be used for other conditions like preeclampsia or eclampsia.

2. Which lab value should be monitored for a patient on warfarin therapy?

• A. Monitor INR
• B. Monitor potassium levels
• C. Monitor platelet count
• D. Monitor sodium levels

Correct answer: A

Rationale: The correct answer is to monitor INR for a patient on warfarin therapy. INR monitoring is crucial as it helps assess the therapeutic effectiveness and safety of warfarin. INR stands for International Normalized Ratio, and it measures the blood's ability to clot. Monitoring potassium levels (Choice B) is not specific to warfarin therapy. Monitoring platelet count (Choice C) is important but not the primary lab value for assessing warfarin therapy. Monitoring sodium levels (Choice D) is not directly related to warfarin therapy.

3. A healthcare provider is assessing a client who has bacterial meningitis. Which of the following findings should the healthcare provider expect?

• A. Nuchal rigidity.
• B. Flaccid paralysis.
• C. Bradycardia.
• D. Hypothermia.

Correct answer: A

Rationale: Nuchal rigidity is a classic sign of bacterial meningitis and indicates inflammation of the meninges. It is characterized by neck stiffness and pain upon neck flexion. Flaccid paralysis (Choice B) is not typically associated with bacterial meningitis but rather conditions like Guillain-Barre syndrome. Bradycardia (Choice C) and hypothermia (Choice D) are not commonly seen in bacterial meningitis; instead, patients may present with fever, tachycardia, and signs of systemic inflammation.

4. A school nurse is teaching a parent about absence seizures. What information should be included?

• A. This type of seizure lasts 30 to 60 seconds.
• B. This type of seizure can be mistaken for daydreaming.
• C. The child usually has an aura prior to onset.
• D. This type of seizure has a gradual onset.

Correct answer: B

Rationale: The correct answer is B because absence seizures are brief and can be mistaken for daydreaming. Choice A is incorrect because absence seizures typically last a few seconds, not 30 to 60 seconds. Choice C is incorrect as absence seizures usually occur suddenly without an aura. Choice D is incorrect because absence seizures have a sudden onset, not a gradual one.

5. A nurse is assessing a client who has a history of angina and reports chest pain. Which of the following actions should the nurse take first?

• A. Administer oxygen at 2 L/min via nasal cannula.
• B. Obtain a 12-lead ECG.
• C. Administer nitroglycerin sublingually.
• D. Notify the provider.

Correct answer: B

Rationale: The correct answer is to obtain a 12-lead ECG. In a client with a history of angina and reporting chest pain, the priority action is to assess for myocardial infarction, which is best done through an ECG. Administering oxygen, nitroglycerin, or notifying the provider can be important actions but obtaining an ECG takes precedence in evaluating the client's condition.

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