Nursing Elites

1. A nurse is caring for a client with congestive heart failure. Which of the following prescriptions should the nurse anticipate?

• A. Call the provider if the respiratory rate is less than 18/min
• B. Administer a 500 mL IV bolus of 0.9% sodium chloride over 1 hour
• C. Administer enalapril 2.5 mg PO twice daily
• D. Call the provider if the client’s pulse rate is less than 80/min

Correct answer: C

Rationale: Enalapril, an ACE inhibitor, is commonly prescribed to manage hypertension and heart failure. It helps reduce the workload on the heart and prevent fluid retention. Options A, B, and D are incorrect. Option A focuses on a respiratory rate, which is not specific to heart failure management. Option B suggests administering a large IV bolus of fluid, which can worsen heart failure by increasing fluid volume. Option D addresses the pulse rate, which is not a typical parameter to monitor for heart failure specifically.

2. A nurse is teaching a group of assistive personnel (AP) about the expected integumentary changes in older adults. Which should the nurse include?

• A. Increase in elasticity
• B. Decrease in pigmentation
• C. Decrease in elasticity
• D. Increase in moisture levels

Correct answer: C

Rationale: The correct answer is C: 'Decrease in elasticity.' As individuals age, they typically experience a decrease in skin elasticity, leading to sagging skin and increased wrinkles. This change in elasticity can contribute to various skin-related issues such as pressure ulcers and delayed wound healing. Choices A, B, and D are incorrect because older adults do not experience an increase in elasticity or moisture levels, and while there may be changes in pigmentation, the primary change related to aging in the integumentary system is a decrease in elasticity.

3. A nurse is discussing immunity with a client who has received an immunization. The nurse should identify that an immunization functions as part of which type of immunity?

• A. Innate immunity
• B. Passive immunity
• C. Acquired immunity
• D. Natural immunity

Correct answer: C

Rationale: The correct answer is C: Acquired immunity. Acquired immunity occurs when an individual is given a vaccine or immunization to develop antibodies. This type of immunity is specific and develops after exposure to an antigen. Innate immunity (choice A) is the body's natural defense system present at birth. Passive immunity (choice B) is temporary immunity passed from one individual to another. Natural immunity (choice D) refers to immunity that is not gained through medical intervention or deliberate exposure.

4. A nurse is assessing a client who has a sodium level of 122 mEq/L. Which of the following findings should the nurse expect?

• A. Decreased deep tendon reflexes
• B. Positive Trousseau’s sign
• C. Hypoactive bowel sounds
• D. Sticky mucous membranes

Correct answer: A

Rationale: A sodium level of 122 mEq/L indicates hyponatremia, which is characterized by decreased deep tendon reflexes. Hyponatremia leads to neurological symptoms such as altered reflexes. Choices B, C, and D are not typically associated with hyponatremia. Positive Trousseau’s sign is related to hypocalcemia, hypoactive bowel sounds can be seen in paralytic ileus or decreased peristalsis, and sticky mucous membranes are not specific findings related to sodium imbalances.

5. When teaching a client about the use of lisinopril, which of the following should be included?

• A. It can cause a persistent cough
• B. It is a calcium channel blocker
• C. It is safe during pregnancy
• D. It should be taken with food

Correct answer: A

Rationale: The correct answer is A. Lisinopril is an ACE inhibitor, and a common side effect associated with its use is a persistent cough. This is important information that the client should be aware of. Choice B is incorrect because lisinopril is not a calcium channel blocker, it is an ACE inhibitor. Choice C is incorrect as lisinopril is not considered safe during pregnancy, especially during the second and third trimesters as it can cause harm to the fetus. Choice D is incorrect because lisinopril is typically recommended to be taken on an empty stomach, about an hour before meals.

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