Nursing Elites

1. The client on a beta blocker has a blood pressure of 88/58 mm Hg. What is the nurse’s priority action?

• A. Hold the beta blocker and notify the healthcare provider.
• B. Administer the beta blocker as ordered.
• C. Increase the dose of the beta blocker.
• D. Continue to monitor the client and reassess in 30 minutes.

Correct answer: A

Rationale: The correct action for the nurse to take when a client on a beta blocker presents with a blood pressure of 88/58 mm Hg is to hold the beta blocker and notify the healthcare provider. Beta blockers can further decrease blood pressure, which is already low in this case. Administering the beta blocker as ordered (Choice B) would exacerbate the hypotension. Increasing the dose of the beta blocker (Choice C) would be inappropriate and unsafe given the low blood pressure. Continuing to monitor the client and reassessing in 30 minutes (Choice D) could lead to a delay in necessary intervention. Therefore, the priority is to hold the medication and seek guidance from the healthcare provider.

2. The nurse is teaching a client about side effects of ACE inhibitors. What is the most important side effect to monitor?

• A. Cough
• B. Hyperkalemia
• C. Hypotension
• D. Dizziness

Correct answer: A

Rationale: The correct answer is A: Cough. ACE inhibitors commonly cause a persistent dry cough in patients. This side effect is important to monitor because it can indicate the development of angioedema, a serious adverse reaction that requires immediate medical attention. Hyperkalemia (choice B) is a potential side effect of ACE inhibitors but is not typically the most important one to monitor. Hypotension (choice C) and dizziness (choice D) are also possible side effects of ACE inhibitors, but they are not as critical to monitor as the development of a persistent cough.

3. What is a type of pneumonia that is contracted by inhaling contaminated water droplets?

• A. Legionnaires' disease
• B. Tuberculosis
• C. Asbestosis
• D. Histoplasmosis

Correct answer: A

Rationale: The correct answer is Legionnaires' disease. Legionnaires' disease is a severe form of pneumonia caused by inhaling water droplets contaminated with Legionella bacteria. This bacterium thrives in water systems such as air conditioning units, hot tubs, and water fountains. Choices B, C, and D are incorrect because Tuberculosis is caused by Mycobacterium tuberculosis, Asbestosis is caused by asbestos fibers, and Histoplasmosis is caused by a fungus found in bird and bat droppings.

4. What is the accumulation of fatty deposits along the walls of arteries, leading to reduced blood flow?

• A. Atherosclerosis
• B. Arteriosclerosis
• C. Aneurysm
• D. Thrombosis

Correct answer: A

Rationale: Atherosclerosis is the correct answer. It refers to the buildup of fatty deposits (plaque) along the inner walls of arteries, narrowing the blood vessels and reducing blood flow. This condition can lead to serious complications such as heart attacks or strokes. Arteriosclerosis (choice B) is a broader term that refers to the thickening and hardening of the arterial walls. While related, it is not as specific as atherosclerosis in describing the fatty deposit accumulation. Aneurysm (choice C) is the abnormal bulging of an artery wall that can rupture and cause internal bleeding, not specifically related to fatty deposits. Thrombosis (choice D) is the formation of a blood clot within a blood vessel, which can obstruct blood flow, but it is not directly related to the accumulation of fatty deposits.

5. The client on warfarin has an INR of 3.8. What is the most appropriate action by the nurse?

• A. Administer vitamin K.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Notify the healthcare provider immediately.

Correct answer: A

Rationale: An INR of 3.8 is elevated, indicating an increased risk of bleeding. Administering vitamin K can help reverse the effects of warfarin. Holding the next dose of warfarin would be appropriate if the INR was too high, but not as the first-line action. Increasing the dose of warfarin would worsen the situation by further increasing the INR. Notifying the healthcare provider is important, but immediate action to address the elevated INR is necessary.

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