Nursing Elites

1. During an intake screening for a patient with hypertension who has been taking ramipril for 4 weeks, which statement made by the patient would be most important for the nurse to pass on to the physician?

• A. ''I get dizzy when I get out of bed.''
• B. ''I'm urinating much more than I used to.''
• C. ''I've been running on the treadmill for 10 minutes each day.''
• D. ''I can't get rid of this cough.''

Correct answer: D

Rationale: The correct answer is ''I can't get rid of this cough.'' Ramipril, an ACE inhibitor, commonly causes a persistent, dry cough as an adverse effect. This symptom can be indicative of bradykinin accumulation caused by ACE inhibitors. It is important for the nurse to inform the physician about this side effect so that a medication change to another class of antihypertensives, such as an ARB, may be considered. Choices A, B, and C are not directly related to the common adverse effects of ramipril and are not as concerning for a patient on this medication.

2. A 23-year-old woman is admitted to the infusion clinic after a Multiple Sclerosis exacerbation. The physician orders methylprednisolone infusions (Solu-Medrol). The nurse would expect which of the following outcomes after administration of this medication?

• A. A decrease in muscle spasticity and involuntary movements
• B. A slowed progression of Multiple Sclerosis-related plaques
• C. A decrease in the length of the exacerbation
• D. A stabilization of mood and sleep

Correct answer: C

Rationale: Methylprednisolone infusion is the first-line treatment during an acute exacerbation of Multiple Sclerosis. It is used to decrease the length and severity of a relapse by reducing inflammation in the central nervous system. Choice A, 'A decrease in muscle spasticity and involuntary movements,' is incorrect because methylprednisolone primarily targets inflammation and does not directly address muscle spasticity. Choice B, 'A slowed progression of Multiple Sclerosis-related plaques,' is incorrect as methylprednisolone is not used to slow the progression of the disease but rather to manage acute exacerbations. Choice D, 'A stabilization of mood and sleep,' is not an expected outcome of methylprednisolone administration for Multiple Sclerosis exacerbation as it primarily targets the inflammatory process associated with the relapse.

3. When assessing a patient suspected to have Hepatitis, a nurse notes the patient's eyes are yellow-tinged. Which of the following diagnostic results would further assist in confirming this diagnosis?

• A. Decreased serum Bilirubin
• B. Elevated serum ALT levels
• C. Low RBC and Hemoglobin with increased WBCs
• D. Increased Blood Urea Nitrogen level

Correct answer: B

Rationale: Elevated serum ALT levels would further confirm the diagnosis of Hepatitis. ALT is a liver enzyme, and hepatitis is a liver disease. Elevated liver enzymes, such as ALT, often indicate liver damage. Choice A, 'Decreased serum Bilirubin,' is incorrect as elevated bilirubin levels are typically seen in hepatitis due to impaired bilirubin metabolism. Choices C and D are unrelated to confirming a diagnosis of hepatitis as they describe findings not specific to liver function or hepatitis. Low RBC and Hemoglobin with increased WBCs (Choice C) suggest a different condition like anemia or infection, not specific to liver disease. Increased Blood Urea Nitrogen level (Choice D) is more indicative of kidney function rather than liver function, thus not helpful in confirming hepatitis.

4. The parent of an infant diagnosed with gastroesophageal reflux disease is receiving feeding instructions from the nurse. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis?

• A. Provide smaller, more frequent feedings.
• B. Burp the infant frequently during feedings.
• C. Thin the feedings by adding water to the formula.
• D. Thicken the feedings by adding rice cereal to the formula.

Correct answer: D

Rationale: Gastroesophageal reflux disease involves the backward flow of gastric contents into the esophagus due to sphincter issues. To reduce episodes of emesis, it is recommended to thicken feedings by adding rice cereal to the formula. This helps to weigh down the contents in the stomach, making regurgitation less likely. Providing smaller, more frequent feedings and burping the infant frequently are beneficial strategies for gastroesophageal reflux. However, in this case, thickening the feedings is the most appropriate intervention. Thinning the feedings by adding water to the formula is not recommended as it can decrease the caloric density of the formula and may not help in reducing reflux.

5. The nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which action should the nurse take first?

• A. Assist the patient to sit upright in a chair.
• B. Splint the patient's chest during coughing.
• C. Medicate the patient with prescribed morphine.
• D. Observe the patient use the incentive spirometer.

Correct answer: C

Rationale: The correct answer is to medicate the patient with prescribed morphine. A major reason for atelectasis and poor airway clearance in patients after chest surgery is incisional pain, which can worsen with deep breathing and coughing. The priority is to address the incisional pain to facilitate effective coughing and deep breathing, which are essential for clearing the airways and preventing complications. Assisting the patient to sit upright, splinting the patient's chest during coughing, and observing the patient using the incentive spirometer are all appropriate interventions to improve airway clearance, but they should be implemented after addressing the incisional pain with medication.

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