Nursing Elites

1. The healthcare provider is setting up the bedside unit for a client being admitted to the nursing unit from the emergency department with a diagnosis of coronary artery disease (CAD). The provider should place the highest priority on making sure that which is available at the bedside?

• A. Bedside commode
• B. Rolling shower chair
• C. Oxygen tubing and flowmeter
• D. Twelve-lead electrocardiogram (ECG) machine

Correct answer: C

Rationale: In a client with coronary artery disease (CAD), ensuring the availability of oxygen and a flowmeter at the bedside is crucial. Oxygen is essential for adequate oxygenation, which helps prevent myocardial ischemia, a common complication in CAD. The other options, such as a bedside commode and rolling shower chair, are important for patient comfort and mobility but are not as critical as ensuring proper oxygen supply in a client with CAD. While having an ECG machine available is important for ongoing monitoring, ensuring oxygen availability takes precedence in this scenario.

2. A client has a new prescription for captopril. Which of the following instructions should the nurse include?

• A. Take the medication with food.
• B. Monitor for signs of hypokalemia.
• C. Take the medication at bedtime.
• D. Monitor for a dry cough.

Correct answer: D

Rationale: The correct answer is to monitor for a dry cough. Captopril is known to cause a persistent dry cough as a common side effect. If a dry cough develops, it should be reported to the healthcare provider promptly, as it may necessitate discontinuation of the medication. Choice A is incorrect because captopril is usually taken on an empty stomach. Choice B is incorrect as hypokalemia is not a common side effect of captopril. Choice C is incorrect as captopril is typically taken during the day and not specifically at bedtime.

3. The client is receiving intravenous heparin for the treatment of a pulmonary embolism. Which medication should the nurse ensure is readily available?

• A. Protamine sulfate
• B. Vitamin K
• C. Calcium gluconate
• D. Magnesium sulfate

Correct answer: A

Rationale: Protamine sulfate is the antidote for heparin, used to reverse its anticoagulant effects. It should be readily available in case of bleeding complications, as it can rapidly neutralize the effects of heparin and prevent excessive bleeding. Vitamin K is used to reverse the effects of warfarin, not heparin (Choice B). Calcium gluconate is used to treat calcium deficiencies, not indicated for heparin therapy (Choice C). Magnesium sulfate is used for conditions like preeclampsia and eclampsia, not for reversing heparin effects (Choice D).

4. The client is receiving anticoagulant therapy for atrial fibrillation. Which laboratory test should be monitored to determine the effectiveness of the therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Platelet count
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: A

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of anticoagulant therapy in clients with atrial fibrillation. These tests help ensure that the client is within the therapeutic range and are commonly used to assess the clotting ability of the blood. Monitoring PT and INR levels allows healthcare providers to adjust anticoagulant dosages as needed to prevent complications such as bleeding or thrombosis. Activated partial thromboplastin time (aPTT) is more commonly used to monitor heparin therapy, not anticoagulant therapy for atrial fibrillation. Platelet count assesses the number of platelets in the blood and is not a direct indicator of anticoagulant therapy effectiveness. Erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and is not used to monitor anticoagulant therapy.

5. The client's B-type natriuretic peptide (BNP) level is 691 pg/mL. Which intervention should the nurse implement when providing care for the client?

• A. Take daily weights and monitor trends.
• B. Encourage fluid intake to improve hydration.
• C. Elevate the legs above the level of the heart.
• D. Position the client supine with the head of the bed at 30 degrees.

Correct answer: A

Rationale: Elevated BNP levels are indicative of heart failure, which often causes fluid retention and weight gain. Taking daily weights and monitoring trends allows the nurse to assess for changes in fluid status. This intervention helps in evaluating the effectiveness of the treatment plan and identifying worsening heart failure symptoms early. Encouraging fluid intake (Choice B) might exacerbate fluid overload in a client with elevated BNP levels. Elevating the legs (Choice C) and positioning the client supine with the head of the bed at 30 degrees (Choice D) are interventions more suitable for clients with hypotension, not specifically indicated for managing elevated BNP levels.

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