Nursing Elites

1. A nurse is caring for a client with a new prescription for enoxaparin to prevent DVT. Which of the following is an appropriate action by the nurse?

• A. Expel any air bubbles from the prefilled syringe
• B. Inject the medication in the lateral abdominal wall
• C. Massage the injection site to evenly distribute the medication
• D. Administer NSAIDs for injection site discomfort

Correct answer: B

Rationale: The correct answer is to inject enoxaparin in the lateral abdominal wall. This site is typically recommended for subcutaneous injections of this medication. Expelling air bubbles from prefilled syringes is not necessary and may result in medication loss. Massaging the injection site is contraindicated as it can cause bruising or hematoma formation. Administering NSAIDs for injection site discomfort is unnecessary and not a standard practice.

2. A nurse is caring for a client with end-stage osteoporosis who is experiencing severe pain and a respiratory rate of 14/min. Which medication should the nurse prioritize?

• A. Promethazine
• B. Hydromorphone
• C. Ketorolac
• D. Amitriptyline

Correct answer: B

Rationale: In this situation, the nurse should prioritize administering Hydromorphone (choice B), an opioid analgesic, to manage the severe pain effectively. Opioids are the first-line treatment for severe pain, especially in end-stage conditions like osteoporosis. Promethazine (choice A) is an antihistamine and antiemetic, not a potent analgesic. Ketorolac (choice C) is a nonsteroidal anti-inflammatory drug (NSAID) that may not provide sufficient pain relief in severe cases. Amitriptyline (choice D) is a tricyclic antidepressant used for neuropathic pain and depression, but it is not the first choice for managing severe pain in this scenario.

3. A client with heart failure is receiving discharge teaching. Which statement by the client indicates an understanding of the teaching?

• A. I will weigh myself once a week.
• B. I will take my diuretic medication in the evening.
• C. I will limit my fluid intake to 3 liters per day.
• D. I will call my doctor if I notice swelling in my feet.

Correct answer: D

Rationale: The correct answer is D. Swelling in the feet can indicate worsening heart failure due to fluid retention, and clients should report this to their healthcare provider immediately. Choices A, B, and C are incorrect because weighing once a week may not provide timely information on fluid retention, timing of diuretic medication is usually advised in the morning to prevent nocturia, and limiting fluid intake to 3 liters per day may not be appropriate for all clients with heart failure.

4. A nurse is administering a blood transfusion to a client and suspects that the client is having an adverse reaction to the blood. Which of the following actions should the nurse take first?

• A. Maintain IV access
• B. Obtain the client’s vital signs
• C. Contact the provider
• D. Stop the transfusion

Correct answer: D

Rationale: The correct answer is to stop the transfusion. When a nurse suspects an adverse reaction to a blood transfusion, the priority is to stop the infusion immediately to prevent further harm to the client. Maintaining IV access and obtaining vital signs can be important steps but should come after stopping the transfusion to ensure the client's safety. Contacting the provider is necessary but not the first action to take in this situation. Therefore, the nurse should prioritize stopping the transfusion to address the potential adverse reaction.

5. A nurse is caring for a newborn who is 1 hour old and has a respiratory rate of 50 breaths per minute with periods of apnea lasting up to 10 seconds. Which of the following actions should the nurse take?

• A. Administer oxygen
• B. Stimulate the newborn
• C. Initiate positive pressure ventilation
• D. Continue routine monitoring

Correct answer: D

Rationale: A respiratory rate of 50 breaths per minute with occasional periods of apnea lasting less than 15 seconds is normal for a newborn. The nurse should continue routine monitoring unless the apneic periods become prolonged or the newborn shows signs of respiratory distress. Administering oxygen or initiating positive pressure ventilation is not indicated in this scenario as the newborn's respiratory rate and apneic episodes are within normal limits for their age. Stimulating the newborn is also unnecessary since the described parameters fall within the expected range for a 1-hour-old infant.

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