Nursing Elites

1. A nurse is caring for a client who has a nasogastric (NG) tube and is receiving enteral feedings. The client reports feeling nauseated. Which of the following actions should the nurse take first?

• A. Administer an antiemetic.
• B. Check the client’s bowel sounds.
• C. Slow the rate of the feeding.
• D. Place the client in a supine position.

Correct answer: B

Rationale: The correct action for the nurse to take first when a client with a nasogastric tube reports feeling nauseated is to check the client's bowel sounds. This assessment helps the nurse evaluate for possible complications, such as a blockage or decreased gastric motility, that could be causing the nausea. Administering an antiemetic (Choice A) should not be the first action without assessing the underlying cause of the nausea. Slowing the rate of the feeding (Choice C) may be appropriate but is not the priority until further assessment is done. Placing the client in a supine position (Choice D) is not typically indicated for managing nausea in this situation.

2. A client is prescribed digoxin for heart failure. Which of the following should the nurse monitor to evaluate the effectiveness of the medication?

• A. Respiratory rate
• B. Blood pressure
• C. Apical pulse
• D. Urine output

Correct answer: C

Rationale: The correct answer is C: Apical pulse. Digoxin's primary effect is to strengthen the force of the heart's contractions and slow the heart rate. Monitoring the apical pulse is crucial in evaluating the effectiveness of digoxin as it helps assess the medication's impact on the heart's function. Option A, respiratory rate, is not directly related to digoxin's mechanism of action and is not the most appropriate parameter to monitor for this medication. Option B, blood pressure, while important, may not be as sensitive as the apical pulse in assessing the effectiveness of digoxin. Option D, urine output, is more indicative of kidney function and fluid balance, rather than the direct effectiveness of digoxin in heart failure.

3. A nurse is preparing to assist a provider with the insertion of a nontunneled percutaneous central venous catheter into a client’s subclavian vein. Which of the following actions should the nurse take?

• A. Position the client in a high-Fowler’s position
• B. Place the client in Trendelenburg position
• C. Place a rolled towel under the client’s neck
• D. Assist the client into a side-lying position

Correct answer: B

Rationale: The correct action for the nurse to take when assisting with the insertion of a nontunneled percutaneous central venous catheter into the subclavian vein is to place the client in Trendelenburg position. This position helps distend the veins and reduces the risk of air embolism during the insertion procedure. Option A, positioning the client in a high-Fowler’s position, would not be appropriate as it does not facilitate venous distention. Option C, placing a rolled towel under the client’s neck, is not directly related to the procedure and does not serve a specific purpose in this context. Option D, assisting the client into a side-lying position, is also not the correct choice as Trendelenburg position is preferred for this procedure to aid in vein distention.

4. A nurse is reviewing laboratory results for a client receiving chemotherapy. Which result should the nurse report to the provider?

• A. WBC 3,000/mm³
• B. Hemoglobin 12 g/dL
• C. Platelet count 250,000/mm³
• D. Serum sodium 140 mEq/L

Correct answer: A

Rationale: The correct answer is A: WBC 3,000/mm³. A WBC count of 3,000/mm³ indicates neutropenia, which is a condition characterized by a low level of white blood cells, specifically neutrophils. Neutropenia increases the risk of infection and requires immediate medical attention, especially in clients undergoing chemotherapy. Reporting this result to the provider promptly is crucial for further evaluation and intervention. Choices B, C, and D are within normal ranges and do not pose an immediate risk to the client's health. Hemoglobin of 12 g/dL, platelet count of 250,000/mm³, and serum sodium of 140 mEq/L are all normal values and would not typically require immediate reporting unless there are specific concerns related to the individual client's condition.

5. A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. Which of the following medications should the nurse plan to administer?

• A. Digoxin
• B. Calcium gluconate
• C. Vitamin B6
• D. Propranolol

Correct answer: C

Rationale: The correct answer is C: Vitamin B6 (pyridoxine). Vitamin B6 is often used to treat nausea and vomiting in pregnancy, including hyperemesis gravidarum. It is considered safe for use in pregnant clients. Digoxin (Choice A) is a medication used for heart conditions, not for hyperemesis gravidarum. Calcium gluconate (Choice B) is used to treat calcium deficiencies, not nausea and vomiting in pregnancy. Propranolol (Choice D) is a beta-blocker used for conditions like hypertension and anxiety, not for hyperemesis gravidarum.

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