Nursing Elites

1. What is the appropriate action when a patient presents with chest pain?

• A. Administer aspirin
• B. Administer nitroglycerin
• C. Reposition the patient
• D. Prepare for surgery

Correct answer: A

Rationale: The appropriate action when a patient presents with chest pain is to administer aspirin. Aspirin helps reduce the risk of clot formation by inhibiting platelet aggregation, which can be beneficial in cases of myocardial infarction. Nitroglycerin is commonly used for chest pain related to angina but is not the first-line treatment for all types of chest pain. Repositioning the patient may be necessary for comfort or assessment but is not the immediate priority. Surgery is not typically the first-line intervention for chest pain unless there are specific indications.

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

• A. Take this medication at bedtime to prevent nausea.
• B. Take this medication with a full glass of milk.
• C. Notify your provider if you experience visual disturbances.
• D. Report any muscle pain to your provider.

Correct answer: C

Rationale: The correct answer is C: 'Notify your provider if you experience visual disturbances.' Visual disturbances can indicate digoxin toxicity, so it is essential for clients taking digoxin to report any changes in vision to their healthcare provider. Option A is incorrect because the timing of digoxin administration is crucial, usually in the morning. Option B is inaccurate because digoxin should not be taken with milk as it can affect its absorption. Option D is not directly associated with digoxin use and should not be the priority instruction for a client on this medication.

3. A nurse is caring for a client who is 1 day postoperative following abdominal surgery. The nurse should suspect that the client has developed an infection based on which of the following findings?

• A. Blood pressure of 110/70 mm Hg
• B. Temperature of 38.5°C (101.3°F)
• C. Heart rate of 92/min
• D. Drainage at the surgical site

Correct answer: B

Rationale: An elevated temperature of 38.5°C (101.3°F) is indicative of infection postoperatively. Fever is a common sign of infection, and temperatures above the normal range should raise suspicion. The other vital signs (blood pressure, heart rate) may be within an acceptable range, and some drainage at the surgical site can be expected postoperatively. However, the elevated temperature is a more specific indicator of a potential infection that requires immediate attention.

4. A nurse is caring for a client who is receiving oxytocin to augment labor. The client's contractions are occurring every 90 seconds with a duration of 90 seconds. Which of the following actions should the nurse take?

• A. Increase oxytocin infusion.
• B. Decrease oxytocin infusion.
• C. Maintain oxytocin infusion.
• D. Discontinue oxytocin infusion.

Correct answer: D

Rationale: The correct action for the nurse to take in this scenario is to discontinue the oxytocin infusion. With contractions occurring every 90 seconds with a duration of 90 seconds, the contractions are too frequent and prolonged, which can lead to uterine rupture or fetal distress. Increasing or maintaining the oxytocin infusion would exacerbate the situation, potentially causing harm to the mother and fetus. Decreasing the oxytocin infusion might not be sufficient to address the issue, making discontinuation the most appropriate action to ensure the safety of both the client and the baby.

5. Which medication is commonly prescribed for a patient with a history of heart failure?

• A. Furosemide
• B. Metoprolol
• C. Digoxin
• D. Aspirin

Correct answer: A

Rationale: Furosemide is the correct answer. It is a common diuretic used in patients with heart failure to reduce fluid overload. Metoprolol (Choice B) is a beta-blocker often prescribed to manage heart failure symptoms by improving heart function. Digoxin (Choice C) is used in heart failure patients to help the heart beat stronger and with a more regular rhythm. Aspirin (Choice D) is not typically prescribed for heart failure but may be used in patients with heart disease for its antiplatelet effects.

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