Nursing Elites

1. What is the appropriate action when a patient experiences an allergic reaction to a medication?

• A. Administer epinephrine
• B. Discontinue the medication
• C. Administer corticosteroids
• D. Administer antihistamines

Correct answer: A

Rationale: The correct answer is to administer epinephrine. Epinephrine is the first-line treatment for a severe allergic reaction as it helps to constrict blood vessels, increase heart rate, and open airways, thereby improving breathing and circulation. Discontinuing the medication may not be sufficient to manage a severe allergic reaction as the allergen is already in the patient's system. Corticosteroids and antihistamines can be considered as complementary treatments but are not the primary immediate intervention required for a severe allergic reaction.

2. A client is 2 hours postoperative following a cholecystectomy. Which of the following interventions should the nurse implement?

• A. Place the client in a supine position
• B. Administer morphine for pain relief
• C. Apply a warm compress to the incision site
• D. Place a pillow under the client's knees

Correct answer: B

Rationale: Administering morphine for pain relief is crucial for postoperative clients following a cholecystectomy to manage pain effectively. Placing the client in a supine position may not be ideal as it can cause discomfort and hinder breathing. Applying a warm compress to the incision site can increase the risk of infection. Placing a pillow under the client's knees is not a priority intervention compared to pain management.

3. What is the most important nursing intervention for a patient with a suspected pulmonary embolism?

• A. Administer anticoagulants
• B. Administer oxygen
• C. Reposition the patient
• D. Monitor oxygen saturation

Correct answer: A

Rationale: The most important nursing intervention for a patient with a suspected pulmonary embolism is to administer anticoagulants. Anticoagulants help prevent further clot formation in the patient's blood vessels, reducing the risk of complications such as worsening of the pulmonary embolism or development of new clots. Administering oxygen (Choice B) may be necessary to support the patient's oxygenation, but anticoagulants take precedence as they target the underlying cause of the pulmonary embolism. Repositioning the patient (Choice C) and monitoring oxygen saturation (Choice D) are important aspects of patient care but are not the primary intervention for a suspected pulmonary embolism.

4. A client is 24 hr postoperative following an abdominal aortic aneurysm resection. Which of the following findings is a priority to report?

• A. Serosanguineous drainage on dressing
• B. Abdominal distention
• C. Absent bowel sounds
• D. Urine output of 20 mL/hr

Correct answer: D

Rationale: Urine output less than 30 mL/hr is indicative of decreased kidney function, potentially due to inadequate perfusion or other complications post-aneurysm resection. This finding requires immediate reporting to prevent further complications such as acute kidney injury. Serosanguineous drainage on the dressing, abdominal distention, and absent bowel sounds are also important postoperative assessments but are not as critical as impaired kidney function in this scenario.

5. How should a healthcare professional educate a patient on the use of an incentive spirometer?

• A. Instruct the patient to take deep breaths
• B. Instruct the patient to cough forcefully
• C. Instruct the patient to blow into the spirometer
• D. Instruct the patient to use the spirometer every hour

Correct answer: D

Rationale: Instructing the patient to use the spirometer every hour is crucial for optimal lung expansion and to prevent postoperative pulmonary complications. This regular use helps to keep the lungs clear and maintain their capacity. Choices A, B, and C are incorrect because deep breathing, forceful coughing, and blowing into the spirometer do not specifically address the proper use of the incentive spirometer, which is essential for postoperative respiratory recovery.

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