Nursing Elites

1. What are the nursing interventions for a patient with hypertension?

• A. Monitor blood pressure and educate the patient about lifestyle changes
• B. Administer antihypertensive medications and provide dietary education
• C. Provide regular monitoring of blood pressure and administer diuretics
• D. Provide regular blood glucose monitoring

Correct answer: A

Rationale: The correct nursing interventions for a patient with hypertension involve monitoring blood pressure and educating the patient about lifestyle changes. These interventions help in managing hypertension by keeping track of the patient's blood pressure readings and empowering them with knowledge to make lifestyle modifications such as adopting a healthy diet, regular exercise, stress management, and avoiding smoking and excessive alcohol consumption. Administering antihypertensive medications (choice B) is typically done by a healthcare provider rather than a nurse. While regular monitoring of blood pressure (choice C) is important, administering diuretics is a specific medical intervention that should be prescribed by a healthcare provider. Monitoring blood glucose (choice D) is more relevant for patients with diabetes rather than hypertension.

2. Which intervention is most important for a client with rheumatoid arthritis?

• A. Massage inflamed joints with creams and oils
• B. Provide support to flexed joints with pillows and pads
• C. Position the client on their abdomen several times a day
• D. Assist with heat application and range of motion exercises

Correct answer: D

Rationale: The most important intervention for a client with rheumatoid arthritis is to assist with heat application and range of motion exercises. Heat application helps reduce stiffness and improve joint flexibility, while range of motion exercises help maintain mobility and prevent contractures. Massaging inflamed joints with creams and oils may provide temporary relief but does not address the root cause of stiffness and limited mobility in rheumatoid arthritis. Providing support to flexed joints with pillows and pads can be helpful for comfort but does not actively promote mobility. Positioning the client on their abdomen several times a day is not a standard intervention for managing rheumatoid arthritis.

3. A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following findings should indicate to the nurse that the medication has been effective?

• A. Cardiac workload decreases
• B. Blood pressure increases
• C. Respiratory rate increases
• D. Temperature decreases

Correct answer: A

Rationale: The correct answer is A: Cardiac workload decreases. Digoxin helps reduce cardiac workload in clients with heart failure, improving symptoms. This reduction in workload indicates that the medication is effective. Choice B, blood pressure increases, is incorrect because digoxin typically does not directly affect blood pressure. Choice C, respiratory rate increases, is incorrect as an increased respiratory rate is not a typical indicator of digoxin effectiveness. Choice D, temperature decreases, is also incorrect as digoxin does not typically affect body temperature.

4. A nurse is caring for a client who delivered a full-term newborn 16 hours ago. The nurse notes excessive lochia discharge. Which of the following actions should the nurse take first?

• A. Administer pain medication
• B. Perform a fundal massage
• C. Check the baby's heart rate
• D. Apply an ice pack

Correct answer: B

Rationale: Performing a fundal massage is the priority action in a postpartum client experiencing excessive lochia discharge. Fundal massage helps prevent postpartum hemorrhage by ensuring the uterus contracts effectively. Administering pain medication, checking the baby's heart rate, and applying an ice pack are not the initial interventions needed to address excessive lochia discharge.

5. A nurse is caring for a client who is 1 day postoperative and is unable to ambulate. Which of the following actions should the nurse take to promote the client's venous return?

• A. Encourage deep breathing exercises
• B. Maintain the client in a supine position
• C. Apply a sequential compression device
• D. Massage the client's legs

Correct answer: C

Rationale: The correct answer is C: Apply a sequential compression device. Applying a sequential compression device promotes venous return by assisting with blood circulation in the lower extremities, reducing the risk of blood clots. Encouraging deep breathing exercises can help with lung expansion but does not directly promote venous return. Maintaining the client in a supine position may not be ideal for promoting venous return if the client is unable to move. Massaging the client's legs may be contraindicated postoperatively due to the risk of dislodging a clot or causing trauma to the surgical site.

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