Nursing Elites

1. A nurse is preparing to administer an IV medication to a client who has an allergy to latex. Which of the following actions should the nurse take?

• A. Use latex gloves when administering the medication.
• B. Use latex-free syringes when administering the medication.
• C. Administer the medication through a latex-free IV port.
• D. Administer the medication with a latex-free syringe.

Correct answer: C

Rationale: The correct action for the nurse to take when preparing to administer IV medication to a client with a latex allergy is to administer the medication through a latex-free IV port. This is crucial as it prevents direct contact of the medication with latex, reducing the risk of an allergic reaction. Choice A is incorrect as using latex gloves can still expose the client to latex. Choice B is not the best option since the administration route is not specified, and using a latex-free syringe alone may not be sufficient to prevent exposure. Choice D is not the most appropriate because the IV tubing and ports should also be latex-free to ensure complete avoidance of latex contact.

2. A nurse is assessing a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. Which of the following findings should the nurse report to the provider?

• A. Respiratory rate of 20/min
• B. Oxygen saturation of 93%
• C. Pain level of 2 on a scale of 0 to 10
• D. Blood pressure of 110/70 mm Hg

Correct answer: D

Rationale: The correct answer is D because a blood pressure drop or other signs of morphine overdose should be reported, especially when using a PCA pump. Choices A, B, and C are within normal limits and do not indicate an immediate concern related to morphine administration.

3. A nurse is providing teaching to a client who is experiencing preterm contractions and dehydration. Which statement should the nurse make?

• A. Dehydration is treated with calcium supplements.
• B. Dehydration can increase the risk of preterm labor.
• C. Dehydration is caused by decreased hemoglobin and hematocrit.
• D. Dehydration causes gastroesophageal reflux.

Correct answer: B

Rationale: The correct statement is B: 'Dehydration can increase the risk of preterm labor.' Dehydration can lead to increased uterine irritability, potentially causing preterm contractions and labor. Choice A is incorrect as dehydration is not treated with calcium supplements but rather with fluids. Choice C is incorrect as dehydration is not caused by decreased hemoglobin and hematocrit levels but rather by a lack of fluids. Choice D is incorrect as dehydration does not directly cause gastroesophageal reflux.

4. A client with osteoporosis is being taught about dietary choices by a nurse. Which of the following foods should the nurse recommend?

• A. Carrots
• B. Milk
• C. Leafy green vegetables
• D. Bananas

Correct answer: C

Rationale: The correct answer is C: Leafy green vegetables. Leafy green vegetables are rich in calcium, which is essential for bone health and can help prevent bone loss in clients with osteoporosis. Carrots (choice A), while nutritious, are not as high in calcium as leafy green vegetables. Milk (choice B) is also a good source of calcium but may not be suitable for clients who are lactose intolerant. Bananas (choice D) are a healthy fruit choice but do not provide significant amounts of calcium needed for osteoporosis.

5. A nurse is caring for a client who is receiving a continuous heparin infusion. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the therapy?

• A. Serum potassium
• B. Platelets
• C. aPTT
• D. INR

Correct answer: C

Rationale: The correct answer is C: aPTT. Monitoring the activated partial thromboplastin time (aPTT) is crucial when a client is receiving heparin therapy. The aPTT reflects the clotting time and helps assess the effectiveness of heparin in preventing clot formation. Keeping the aPTT within the therapeutic range ensures that the medication is working optimally. Choices A, B, and D are incorrect because serum potassium, platelets, and INR are not direct indicators of heparin's effectiveness or therapeutic range.

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