Nursing Elites

1. A nurse on a postpartum unit is receiving change-of-shift report for four clients. Which of the following clients should the nurse see first?

• A. A client who gave birth 1 day ago and needs Rho(D) immune globulin
• B. A client who gave birth 3 days ago and reports breast fullness
• C. A client who gave birth 12 hours ago and reports an increase in urinary output
• D. A client who gave birth 8 hours ago and is saturating a perineal pad every hour

Correct answer: D

Rationale: The nurse should see the client saturating a perineal pad every hour first. This client may be experiencing postpartum hemorrhage, which is a medical emergency requiring immediate assessment and intervention. The other options describe clients with less urgent needs. The client needing Rho(D) immune globulin can wait, the breast fullness in the client who gave birth 3 days ago can be addressed after managing the postpartum hemorrhage, and an increase in urinary output in a client who gave birth 12 hours ago is not indicative of an immediate emergency like postpartum hemorrhage.

2. A nurse is teaching a client about using a continuous positive airway pressure (CPAP) device to treat obstructive sleep apnea. Which of the following information should the nurse include in the teaching?

• A. It delivers a preset amount of inspiratory pressure at the beginning of each breath
• B. It has a continuous adjustment feature that changes the airway pressure throughout the cycle
• C. It delivers a preset amount of airway pressure throughout the breathing cycle
• D. It delivers positive pressure at the end of each breath

Correct answer: C

Rationale: The correct information that the nurse should include in the teaching about a CPAP device is that it delivers a preset amount of airway pressure throughout the breathing cycle. This consistent positive airway pressure helps keep the airway open during both inspiration and expiration. Choice A is incorrect as CPAP does not deliver pressure only at the beginning of each breath. Choice B is incorrect because CPAP provides a constant level of pressure without continuous adjustments throughout the cycle. Choice D is incorrect as CPAP does not provide positive pressure at the end of each breath; instead, it maintains a continuous positive pressure.

3. A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate. Which action should the nurse take if the client develops toxicity?

• A. Administer calcium gluconate IV
• B. Increase the magnesium sulfate infusion
• C. Administer IV fluids
• D. Administer hydralazine

Correct answer: A

Rationale: In cases of magnesium sulfate toxicity, administering calcium gluconate IV is crucial as it is the antidote for magnesium sulfate. Calcium gluconate helps reverse the effects of magnesium sulfate, especially when signs of toxicity like respiratory depression or loss of reflexes occur. Increasing the magnesium sulfate infusion would worsen toxicity. Administering IV fluids may be beneficial for hydration but does not address magnesium sulfate toxicity. Hydralazine is used to manage hypertension, not magnesium sulfate toxicity.

4. A nurse in a provider's office is assessing a client who reports a decrease in the effectiveness of their arthritis medication. Which of the following client information should the nurse identify as a contributing factor?

• A. The client has a history of recurring bowel inflammation.
• B. The client has recently increased their exercise regimen.
• C. The client is taking herbal supplements.
• D. The client is experiencing increased stress.

Correct answer: A

Rationale: The correct answer is A. Recurring bowel inflammation can decrease gastrointestinal motility, affecting the absorption of oral medications. This can lead to decreased effectiveness of the arthritis medication. Choice B is incorrect because increasing exercise would not typically impact the absorption of arthritis medication. Choice C is incorrect as herbal supplements may not directly affect the absorption of conventional arthritis medication. Choice D is also incorrect as stress, while it can impact overall health, is less likely to directly affect the effectiveness of arthritis medication compared to gastrointestinal issues.

5. A nurse is assessing a client with pericarditis. Which of the following findings is the priority for the nurse to report?

• A. Paradoxical pulse
• B. Dependent edema
• C. Pericardial friction rub
• D. Substernal chest pain

Correct answer: A

Rationale: A paradoxical pulse is a sign of cardiac tamponade, a life-threatening complication of pericarditis that requires immediate intervention. It results from decreased cardiac output due to increased pressure in the pericardial sac. Reporting this finding promptly allows for timely treatment to prevent further deterioration. Dependent edema and substernal chest pain are common in pericarditis but are not as urgent as a paradoxical pulse. A pericardial friction rub is a classic finding in pericarditis and indicates inflammation but is not as critical as a paradoxical pulse.

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