Nursing Elites

1. A nurse is caring for a client who has a new prescription for metformin. Which of the following findings in the client's medical history should the nurse report to the provider?

• A. History of hypertension
• B. History of polycystic ovary syndrome
• C. History of asthma
• D. History of kidney disease

Correct answer: D

Rationale: The correct answer is D, history of kidney disease. Metformin should be used with caution in clients with kidney disease due to the risk of lactic acidosis, a serious complication. Reporting this finding to the provider is crucial for assessing the appropriateness of continuing metformin therapy. Choices A, B, and C do not contraindicate the use of metformin, so they are not the priority for reporting.

2. A nurse is caring for a client who is receiving oxytocin to augment labor. The client's contractions are occurring every 2 minutes with a duration of 90 seconds. Which of the following actions should the nurse take?

• A. Increase the oxytocin infusion.
• B. Maintain the oxytocin infusion.
• C. Discontinue the oxytocin infusion.
• D. Provide reassurance to the client.

Correct answer: C

Rationale: The correct action for the nurse to take in this situation is to discontinue the oxytocin infusion. With contractions occurring every 2 minutes and lasting 90 seconds, this pattern indicates hyperstimulation, which can be harmful to the fetus. Discontinuing the oxytocin infusion is essential to prevent further harm. Increasing the oxytocin infusion would exacerbate the situation, maintaining it would continue the risk, and providing reassurance to the client, although important, does not address the need for immediate action to ensure the safety of the fetus.

3. A nurse is reviewing the medical record of a client who has acute kidney injury. Which of the following findings should the nurse report to the provider?

• A. Blood urea nitrogen (BUN) 15 mg/dL
• B. Urine output of 45 mL/hr
• C. Serum creatinine 3.5 mg/dL
• D. Calcium 9 mg/dL

Correct answer: C

Rationale: The correct answer is C, 'Serum creatinine 3.5 mg/dL.' An elevated serum creatinine level indicates worsening kidney function and impaired renal clearance, which should be reported to the provider promptly. Choice A, 'Blood urea nitrogen (BUN) 15 mg/dL,' is within the normal range (7-20 mg/dL) and does not indicate acute kidney injury. Choice B, 'Urine output of 45 mL/hr,' is a low urine output but does not directly reflect kidney function decline. Choice D, 'Calcium 9 mg/dL,' is within the normal calcium range (8.5-10.5 mg/dL) and is not specifically indicative of acute kidney injury.

4. What is the appropriate intervention for a patient with hypertension refusing medication?

• A. Educate the patient on the importance of medication
• B. Respect the patient's decision
• C. Inform the healthcare provider
• D. Explore alternative treatment options

Correct answer: A

Rationale: The correct answer is A: Educate the patient on the importance of medication. Providing education to the patient is crucial in promoting understanding of the condition and the necessity of medication. By enhancing the patient's knowledge, healthcare providers can empower them to make informed decisions regarding their health. Choice B, respecting the patient's decision, may not be appropriate in this scenario as untreated hypertension can lead to serious complications. Choice C, informing the healthcare provider, is important but should be done after attempting to educate the patient. Choice D, exploring alternative treatment options, may be considered if the patient has concerns or side effects related to the medication, but initially, educating the patient about the importance of medication is key.

5. A nurse is preparing to administer a blood transfusion to a client. Which of the following actions should the nurse take?

• A. Monitor the client's vital signs every 4 hours.
• B. Start the transfusion with 0.9% sodium chloride.
• C. Administer the transfusion over 6 hours.
• D. Infuse the first 500 mL of blood over 1 hour.

Correct answer: B

Rationale: The correct answer is B: Start the transfusion with 0.9% sodium chloride. 0.9% sodium chloride is the only IV solution that is compatible with blood products and should be used to prime the tubing before a transfusion. Choice A is incorrect because vital signs should be monitored more frequently, typically every 15 minutes at the beginning of the transfusion. Choice C is incorrect as blood transfusions are usually administered over 2-4 hours, not 6 hours. Choice D is incorrect as the first 500 mL of blood should be infused slowly over 1-2 hours to monitor for any adverse reactions.

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