Nursing Elites

1. The healthcare provider prescribes atenolol 50 mg daily for a client with angina pectoris. Which finding should the nurse report to the healthcare provider before administering this medication?

• A. Irregular pulse.
• B. Tachycardia.
• C. Chest pain.
• D. Urinary frequency.

Correct answer: A

Rationale: The correct answer is A: Irregular pulse. An irregular pulse may indicate an arrhythmia, which could be exacerbated by atenolol, a beta-blocker used to treat angina pectoris. Atenolol works by slowing the heart rate, so if the patient already has an irregular pulse, it could worsen with the medication. Tachycardia (choice B) would actually be an expected finding in a patient with angina pectoris, and atenolol is used to help reduce the heart rate in such cases. Chest pain (choice C) is a symptom that atenolol is meant to alleviate, so it would not be a reason to withhold the medication. Urinary frequency (choice D) is not directly related to the administration of atenolol for angina pectoris and would not require immediate reporting to the healthcare provider.

2. Following discharge teaching, a male client with a duodenal ulcer tells the nurse he will drink plenty of dairy products to help coat and protect his ulcer. What is the best follow-up action by the nurse?

• A. Remind the client that it is also important to switch to decaffeinated coffee and tea.
• B. Suggest that the client also plans to eat frequent small meals to reduce discomfort.
• C. Review with the client the need to avoid foods that are rich in milk and cream.
• D. Reinforce this teaching by asking the client to list a dairy food that he might select.

Correct answer: C

Rationale: The correct answer is C because diets rich in milk and cream stimulate gastric acid secretion, which can exacerbate a duodenal ulcer. Therefore, it is essential to avoid foods that are rich in milk and cream. Choice A is incorrect because switching to decaffeinated coffee and tea does not address the issue of avoiding milk and cream products. Choice B is incorrect because while eating frequent small meals can help with discomfort, it does not address the specific issue of avoiding milk and cream. Choice D is incorrect as it does not address the need to avoid milk and cream products.

3. The nurse is caring for a client who is postoperative following a thyroidectomy. Which laboratory value should be monitored closely?

• A. Serum calcium of 8.5 mg/dL
• B. Serum sodium of 136 mEq/L
• C. Serum potassium of 3.0 mEq/L
• D. Serum chloride of 102 mEq/L

Correct answer: C

Rationale: A serum potassium level of 3.0 mEq/L should be monitored closely in a client who is postoperative following a thyroidectomy to detect any electrolyte imbalances. After a thyroidectomy, there is a risk of hypokalemia due to the effects of anesthesia, stress response, and the surgical procedure itself. Monitoring serum potassium levels is crucial as hypokalemia can lead to cardiac arrhythmias and muscle weakness. Serum calcium, sodium, and chloride levels are important but not the primary focus following a thyroidectomy, making them incorrect choices.

4. A client with a history of chronic heart failure is admitted with shortness of breath and crackles in the lungs. Which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Administer a loop diuretic as prescribed.
• C. Administer intravenous morphine as prescribed.
• D. Obtain an arterial blood gas (ABG) sample.

Correct answer: A

Rationale: Administering oxygen therapy is the priority intervention for a client with chronic heart failure presenting with shortness of breath and crackles in the lungs. Oxygen therapy helps improve oxygenation, which is crucial in managing respiratory distress. Loop diuretics (Choice B) may be indicated to manage fluid overload in heart failure but are not the immediate priority in this case. Administering morphine (Choice C) is not the first-line intervention for shortness of breath in heart failure and should be considered after addressing oxygenation and underlying causes. Obtaining an arterial blood gas sample (Choice D) can provide valuable information but is not the initial action needed to address the client's acute respiratory distress.

5. Following a gunshot wound to the abdomen, a young adult male had an emergency bowel resection and received multiple blood products. His current blood pressure is 78/52 mm Hg, and he is being mechanically ventilated. His oxygen saturation is 87%. Laboratory values indicate hemoglobin of 7 g/dL, platelets of 20,000/mm³, and white blood cells of 2,000/mm³. Which intervention should the nurse implement first?

• A. Transfuse packed red blood cells.
• B. Obtain blood and sputum cultures.
• C. Infuse 1000 ml of normal saline.
• D. Titrate oxygen to keep O2 saturation above 90%.

Correct answer: A

Rationale: The correct answer is to transfuse packed red blood cells first. The client's low hemoglobin level of 7 g/dL indicates severe anemia, which requires immediate transfusion to increase oxygen-carrying capacity. While obtaining blood and sputum cultures (Choice B) is important to identify potential infections, addressing the critical issue of anemia takes precedence. Infusing normal saline (Choice C) may help with volume status but does not address the primary concern of low hemoglobin. Titration of oxygen (Choice D) is crucial, but transfusion to improve oxygen-carrying capacity should be the priority in this scenario.

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