Nursing Elites

1. A client with a new diagnosis of hypertension is being taught by a nurse. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should avoid eating foods high in potassium.
• B. I will check my blood pressure at least once a week.
• C. I should increase my intake of dairy products.
• D. I should exercise for 30 minutes at least 5 days a week.

Correct answer: D

Rationale: The correct answer is D. Exercising for 30 minutes at least 5 days a week helps manage hypertension by promoting cardiovascular health. Statements A, B, and C are incorrect. Avoiding foods high in potassium is not necessary unless specifically advised by a healthcare provider. Checking blood pressure once a week is not frequent enough for effective monitoring. Increasing dairy product intake is not a recommended approach to managing hypertension.

2. A nurse is reviewing the medical history of a client who has angina. Which of the following findings in the client's medical history should the nurse identify as a risk factor for angina?

• A. Hyperlipidemia.
• B. COPD.
• C. Seizure disorder.
• D. Hyponatremia.

Correct answer: A

Rationale: The correct answer is A: Hyperlipidemia. Hyperlipidemia, which is an elevated level of lipids (fats) in the blood, is a well-established risk factor for angina. High levels of lipids can lead to atherosclerosis, a condition where fatty deposits build up in the arteries, reducing blood flow to the heart muscle and increasing the risk of angina. Choice B, COPD (Chronic Obstructive Pulmonary Disease), is not directly linked to an increased risk of angina. COPD primarily affects the lungs and is not a known risk factor for angina. Choice C, Seizure disorder, and Choice D, Hyponatremia (low sodium levels), are also not typically associated with an increased risk of angina. While medical conditions like hypertension, diabetes, and smoking are other common risk factors for angina, hyperlipidemia is specifically known for its impact on blood vessels, making it a key risk factor to identify in a client's medical history.

3. A healthcare professional is reviewing the medical record of a client who has a new prescription for enoxaparin. Which of the following findings should the healthcare professional report to the provider?

• A. Platelet count 150,000/mm³
• B. aPTT 30 seconds
• C. Sodium 140 mEq/L
• D. Serum creatinine 3.0 mg/dL

Correct answer: D

Rationale: An elevated serum creatinine level indicates impaired kidney function, which can affect the metabolism and excretion of enoxaparin, potentially leading to increased drug levels and risk of bleeding. Therefore, it is crucial to report a high serum creatinine level before administering enoxaparin. Platelet count, aPTT, and sodium levels are not directly related to the administration of enoxaparin and would not impact its use; hence, they do not need to be reported before starting the medication.

4. A nurse is assessing a client who has left-sided heart failure. Which of the following should the nurse identify as a manifestation of pulmonary congestion?

• A. Frothy, pink sputum
• B. Jugular vein distention
• C. Weight gain
• D. Bradypnea

Correct answer: A

Rationale: Correct! Frothy, pink sputum is a classic sign of pulmonary congestion in left-sided heart failure. This occurs due to the accumulation of fluid in the lungs, leading to the coughing up of frothy, pink-tinged sputum. Jugular vein distention (choice B) is more indicative of right-sided heart failure, where fluid backs up into the systemic circulation. Weight gain (choice C) may occur due to fluid retention, but it is not a direct manifestation of pulmonary congestion. Bradypnea (choice D) refers to abnormally slow breathing and is not specifically associated with pulmonary congestion.

5. A nurse is preparing to administer an intermittent enteral feeding to a client who has an NG tube. Which of the following actions should the nurse take?

• A. Heat the feeding to 105°F (40.6°C).
• B. Elevate the head of the bed to 45 degrees.
• C. Flush the tube with 0.9% sodium chloride.
• D. Verify the pH of the gastric aspirate.

Correct answer: D

Rationale: Verifying the pH of the gastric aspirate is the correct action to take before administering an intermittent enteral feeding through an NG tube. This step ensures proper tube placement in the stomach, as the gastric aspirate should have an acidic pH (usually below 5). Heating the feeding solution, elevating the head of the bed, or flushing the tube with saline are not directly related to verifying tube placement and are not the immediate actions needed before administering the feeding.

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