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 assessing a client who has pericarditis. Which of the following findings is the priority?

• A. Paradoxical pulse
• B. Dependent edema
• C. Pericardial friction rub
• D. Substernal chest pain

Correct answer: A

Rationale: In a client with pericarditis, the priority finding is a paradoxical pulse. This is a crucial sign of cardiac tamponade, a life-threatening complication of pericarditis where fluid accumulates in the pericardial sac, causing compression of the heart. A paradoxical pulse is an exaggerated decrease in systolic blood pressure (>10 mmHg) during inspiration. Prompt recognition and intervention are essential to prevent hemodynamic instability and cardiac arrest. Dependent edema (choice B) is not typically associated with pericarditis. Pericardial friction rub (choice C) is a common finding in pericarditis but does not indicate the urgency of intervention as a paradoxical pulse. Substernal chest pain (choice D) is a classic symptom of pericarditis but is not as critical as a paradoxical pulse in the context of assessing for complications.

3. A nurse is caring for a client who is in labor and has an external fetal monitor in place. The nurse observes late decelerations in the fetal heart rate. Which of the following findings should the nurse identify as the cause of late decelerations?

• A. Fetal head compression
• B. Uteroplacental insufficiency
• C. Umbilical cord compression
• D. Fetal hypoxia

Correct answer: B

Rationale: Late decelerations in the fetal heart rate are caused by uteroplacental insufficiency, which results from inadequate blood flow to the placenta. This leads to reduced oxygen and nutrients reaching the fetus during contractions. Choice A, fetal head compression, does not typically cause late decelerations but can result in variable decelerations. Choice C, umbilical cord compression, usually leads to variable decelerations. Choice D, fetal hypoxia, is a broad term and not the direct cause of late decelerations, which are specifically linked to uteroplacental insufficiency.

4. A nurse is assessing a client who has deep vein thrombosis (DVT) in the left lower extremity. Which of the following findings should the nurse expect?

• A. Pain in the right lower extremity
• B. Cold skin in the affected extremity
• C. Redness and warmth in the affected extremity
• D. Shiny skin on the affected extremity

Correct answer: C

Rationale: Corrected Rationale: Redness and warmth are classic signs of inflammation, which are commonly seen in clients with deep vein thrombosis (DVT). These findings indicate increased blood flow and temperature in the affected area. Pain in the right lower extremity (Choice A) is not expected in a client with DVT affecting the left lower extremity. Cold skin (Choice B) is not a typical finding in DVT; instead, warmth is more indicative of inflammation. Shiny skin (Choice D) is not a common characteristic of DVT; rather, the skin may appear red, swollen, and warm due to the inflammatory process.

5. A nurse is reviewing the medical record of a client who has a new prescription for enalapril. Which of the following findings should the nurse report to the provider?

• A. Serum potassium 4.0 mEq/L
• B. Sodium 138 mEq/L
• C. Serum creatinine 3.8 mg/dL
• D. Hemoglobin 13 g/dL

Correct answer: C

Rationale: The correct answer is C. An elevated serum creatinine level can indicate impaired kidney function, which is crucial to report before administering enalapril. Enalapril, an ACE inhibitor, can affect kidney function, especially in patients with pre-existing renal impairment. Choices A, B, and D are within normal ranges and do not directly impact the initiation of enalapril therapy.

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