Nursing Elites

1. The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two hours is dated two years ago. The client reports that he has a history of 'heart trouble,' but has no problems at present. Hospital protocol requires that those over 50 years of age have a recent ECG prior to surgery. What nursing action is best for the nurse to implement?

• A. Ask the client to explain what he means by 'heart trouble.'
• B. Call for an ECG to be performed immediately.
• C. Notify surgery that the ECG is over two years old.
• D. Notify the client's surgeon immediately.

Correct answer: B

Rationale: In this scenario, the client is 55 years old with a history of 'heart trouble,' which necessitates a recent ECG before surgery as per hospital policy. The nurse should prioritize patient safety and adhere to the protocol by arranging for an ECG to be performed immediately. Option A is not the best initial action as the focus should be on obtaining the necessary test first. Option C is not the immediate action required, and option D is premature without obtaining the necessary ECG first.

2. A nurse administers scopolamine as prescribed to a client in preparation for surgery. For which side effect of this medication does the nurse monitor the client?

• A. Pupil constriction
• B. Increased urine output
• C. Complaints of dry mouth
• D. Complaints of feeling sweaty

Correct answer: D

Rationale: The correct answer is D: 'Complaints of feeling sweaty.' Scopolamine, an anticholinergic medication, commonly causes the side effect of decreased sweating, not increased urine output or pupil constriction. While dry mouth is a possible side effect, it is less likely than the altered sweating pattern. Therefore, the nurse should monitor the client for complaints of feeling sweaty due to the potential side effect of decreased sweating associated with scopolamine.

3. The nurse is assessing an older adult with a pacemaker who leads a sedentary lifestyle. The client reports being unable to perform activities that require physical exertion. The nurse should further assess the client for which of the following?

• A. Left ventricular atrophy.
• B. Irregular heartbeats.
• C. Peripheral vascular occlusion.
• D. Pacemaker function.

Correct answer: A

Rationale: The correct answer is A: Left ventricular atrophy. Older adults who lead sedentary lifestyles are at risk of developing left ventricular atrophy, which can lead to decreased cardiac output during physical exertion. This condition can contribute to the client's inability to perform activities requiring physical exertion. Choice B, irregular heartbeats, may be a consideration due to the presence of a pacemaker, but the client's reported inability to perform physically exerting activities is more indicative of a structural issue like left ventricular atrophy rather than a rhythm-related problem. Peripheral vascular occlusion (Choice C) is less likely to be the cause of the client's symptoms compared to the cardiac-related issue of left ventricular atrophy. While assessing pacemaker function (Choice D) is important, the client's symptoms are more suggestive of a cardiac structural issue rather than a malfunction of the pacemaker.

4. What is the most common symptom of gastroesophageal reflux disease (GERD)?

• A. Heartburn.
• B. Nausea.
• C. Abdominal pain.
• D. Vomiting.

Correct answer: A

Rationale: The correct answer is A: Heartburn. Heartburn is the most common symptom of GERD as it occurs due to the reflux of stomach acid into the esophagus. This leads to a burning sensation in the chest that can worsen after eating, lying down, or bending over. Choice B, Nausea, is not typically the most common symptom of GERD, although it can occur in some cases. Choice C, Abdominal pain, is not a primary symptom of GERD and is more commonly associated with other gastrointestinal conditions. Choice D, Vomiting, is also not the most common symptom of GERD, although it can occur in severe cases or as a result of complications.

5. The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L. The nurse performs a drug history prior to beginning the infusion. Which drug taken by the patient would cause concern?

• A. Digitalis
• B. Hydrochlorothiazide
• C. Hydrocortisone
• D. Vitamin D

Correct answer: A

Rationale: Calcium gluconate is administered to treat hyperkalemia by reducing myocardial irritability. When given to a patient taking digitalis, it can lead to digitalis toxicity. Digitalis and calcium gluconate both affect cardiac function, and their concomitant use can potentiate adverse effects. Hydrochlorothiazide, Hydrocortisone, and Vitamin D may impact potassium levels, but they do not interact with calcium gluconate in a way that would cause concern for toxicity.

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