Nursing Elites

1. The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250 ml of D5W at 300 mcg/hour. The nurse should program the infusion pump to deliver how many ml/hour?

• A. 50 ml/hour
• B. 25 ml/hour
• C. 75 ml/hour
• D. 100 ml/hour

Correct answer: C

Rationale: To calculate the infusion rate, convert 1 mg to 1,000 mcg (1 mg = 1,000 mcg) and then use the formula D/H x Q, where D is the desired dose, H is the dose on hand, and Q is the quantity of solution. In this case, it would be 300 mcg/hour / 1,000 mcg x 250 ml = 75 ml/hour. Therefore, the nurse should program the infusion pump to deliver 75 ml/hour. Choice A (50 ml/hour), Choice B (25 ml/hour), and Choice D (100 ml/hour) are incorrect as they do not correspond to the calculated rate of 75 ml/hour.

2. A client with a history of atrial fibrillation is receiving warfarin (Coumadin). Which laboratory value should the nurse monitor closely?

• A. International Normalized Ratio (INR)
• B. Prothrombin time (PT)
• C. Serum sodium level
• D. Hemoglobin level of 12 g/dl

Correct answer: A

Rationale: The correct answer is A: International Normalized Ratio (INR). The INR should be closely monitored in a client receiving warfarin (Coumadin) to assess the effectiveness and safety of anticoagulation therapy. Monitoring the INR helps ensure that the client is within the therapeutic range to prevent both bleeding and clotting events. Choices B, C, and D are incorrect because while PT is used to monitor warfarin therapy, INR is a more precise indicator of therapeutic levels. Serum sodium level and hemoglobin level are not directly related to monitoring warfarin therapy.

3. A client with a history of chronic heart failure is admitted with shortness of breath and crackles in the lungs. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Chest X-ray
• B. Arterial blood gases (ABGs)
• C. Echocardiogram
• D. Electrocardiogram (ECG)

Correct answer: C

Rationale: The correct answer is C: Echocardiogram. An echocardiogram should be performed first to assess ventricular function and evaluate the cause of shortness of breath and crackles in a client with heart failure. An echocardiogram provides valuable information about the heart's structure and function, helping to identify potential issues related to heart failure. Chest X-ray (Choice A) may be done to assess for changes in heart size or fluid in the lungs but does not directly assess heart function. Arterial blood gases (Choice B) may provide information about oxygenation but do not directly evaluate heart function. An electrocardiogram (Choice D) assesses the heart's electrical activity but does not provide detailed information about ventricular function, which is crucial in heart failure management.

4. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which clinical finding requires immediate intervention?

• A. Fever of 100.4°F
• B. Heart rate of 110 beats per minute
• C. Blood pressure of 140/90 mmHg
• D. Respiratory rate of 24 breaths per minute

Correct answer: A

Rationale: A fever of 100.4°F is a clinical finding that requires immediate intervention in a client with ESRD scheduled for hemodialysis. Fever may indicate an underlying infection, which can be severe in individuals with compromised renal function. Prompt assessment and treatment are essential to prevent worsening of the infection and potential complications. Heart rate, blood pressure, and respiratory rate are also important parameters to monitor in clients with ESRD, but in this scenario, the fever takes precedence due to its potential to indicate a critical condition that requires urgent attention.

5. A woman who takes pyridostigmine for myasthenia gravis (MG) arrives at the emergency department complaining of extreme muscle weakness. Her adult daughter tells the nurse that since yesterday her mother has been unable to smile. Which assessment finding warrants immediate intervention by the nurse?

• A. Uncontrollable drooling.
• B. Inability to raise voice.
• C. Tingling of extremities.
• D. Eyelid drooping.

Correct answer: A

Rationale: Uncontrollable drooling can be a sign of a myasthenic crisis, which requires immediate medical intervention to prevent respiratory failure. Drooling indicates difficulty in swallowing, which can lead to aspiration and respiratory compromise. Inability to raise voice (choice B) and tingling of extremities (choice C) are not typically associated with myasthenic crisis. Although eyelid drooping (choice D) is a common symptom of myasthenia gravis, it is not as urgent as uncontrollable drooling in indicating a potential crisis.

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