Nursing Elites

1. A nurse is observing bonding between a client and her newborn. Which of the following actions by the client requires the nurse to intervene?

• A. Holding the newborn in an en face position
• B. Asking the father to change the newborn's diaper
• C. Requesting the nurse to take the newborn to the nursery so she can rest
• D. Viewing the newborn's actions as uncooperative

Correct answer: D

Rationale: The correct answer is D because viewing the newborn's actions as uncooperative indicates a lack of bonding, which requires intervention. Choices A, B, and C all involve appropriate and caring actions by the client towards the newborn. Holding the newborn in an en face position promotes bonding, involving the father in caring for the newborn is beneficial for family involvement, and requesting rest by asking the nurse to take the newborn to the nursery is a responsible action to ensure both the client and the newborn get adequate rest.

2. What is the first intervention for a patient experiencing anaphylactic shock?

• A. Administer epinephrine
• B. Administer corticosteroids
• C. Administer antihistamines
• D. Administer oxygen

Correct answer: A

Rationale: The correct answer is to administer epinephrine as the first intervention for a patient experiencing anaphylactic shock. Epinephrine is crucial in reversing the allergic reaction and restoring cardiovascular stability. Corticosteroids (Choice B) are not the first-line treatment for anaphylactic shock but may be used as an adjunct therapy. Antihistamines (Choice C) can help relieve itching and hives but are not as effective as epinephrine in treating the systemic effects of anaphylaxis. Oxygen (Choice D) may be necessary to support breathing in severe cases of anaphylaxis, but administering epinephrine takes precedence in the management of anaphylactic shock.

3. A client who is 1 day postpartum plans to breastfeed. Which statement indicates an understanding of the teaching provided by the nurse?

• A. I will breastfeed every 4 hours.
• B. I will feed my baby from each breast for 5 minutes.
• C. I will use both breasts at each feeding.
• D. I will pump my breasts if my baby does not wake up to feed.

Correct answer: C

Rationale: The correct answer is C. Using both breasts at each feeding helps ensure adequate milk production and consumption. Option A is incorrect because breastfeeding should be done on demand rather than following a strict schedule. Option B is incorrect as limiting feeding time to 5 minutes per breast may not provide the baby with enough milk. Option D is also incorrect as pumping should not replace direct breastfeeding unless there is a specific medical reason to do so.

4. A client has a new prescription for furosemide. Which of the following instructions should the nurse include?

• A. Take this medication with a meal.
• B. Increase your intake of potassium-rich foods.
• C. Avoid prolonged exposure to sunlight.
• D. Limit your intake of calcium-rich foods.

Correct answer: B

Rationale: The correct instruction for a client taking furosemide is to increase their intake of potassium-rich foods. Furosemide is a loop diuretic that can lead to potassium loss, so increasing potassium-rich foods helps prevent hypokalemia. Choice A is incorrect because furosemide is usually taken on an empty stomach. Choice C is unrelated to furosemide therapy. Choice D is incorrect as there is no need to limit calcium-rich foods while taking furosemide.

5. While caring for a client receiving a blood transfusion who reports chills, which action should the nurse take first?

• A. Stop the transfusion.
• B. Administer acetaminophen as prescribed.
• C. Notify the provider.
• D. Check the client's blood pressure.

Correct answer: A

Rationale: The correct action for the nurse to take first when a client reports chills during a blood transfusion is to stop the transfusion. Chills can indicate a transfusion reaction, which is a potentially serious situation. Stopping the transfusion immediately is crucial to prevent further complications. Administering acetaminophen or checking the client's blood pressure can come after ensuring the safety of the client by stopping the transfusion. Notifying the provider is important, but the immediate priority is to stop the transfusion.

Similar Questions