Nursing Elites

1. A 37-year-old female client asks the nurse about contraception options and expresses interest in oral contraception pills. Which of the following statements would indicate that oral contraception is appropriate for this client?

• A. "I quit smoking last year, but I started again recently. Maybe I'll try to quit later this year."?
• B. "I am very diligent in taking my thyroid medications at the same time every day."?
• C. "I was hospitalized for deep vein thrombosis five years ago."?
• D. "I was recently diagnosed with breast cancer."?

Correct answer: C

Rationale: The correct answer is the statement mentioning a history of deep vein thrombosis five years ago. Oral contraceptives are generally not recommended for individuals with a history of deep vein thrombosis due to the increased risk of blood clots. Choice B, about being diligent in taking thyroid medications, does not directly relate to the safety of using oral contraceptives. Choice D, about a recent breast cancer diagnosis, would contraindicate the use of hormonal contraceptives. Choice A, mentioning a recent return to smoking, raises concerns about using hormonal contraceptives due to the increased risk of cardiovascular complications.

2. A nurse assisting with data collection is testing the cochlear portion of the acoustic nerve (cranial nerve VIII). Which action does the nurse take to test this nerve?

• A. Asking the client to raise their eyebrows and looking for symmetry
• B. Asking the client to clench the teeth, then palpating the masseter muscles just above the mandibular angle
• C. Asking the client to close the eyes and then identify light and sharp touch with a cotton ball and a pin on both sides of the face
• D. Asking the client to close their eyes and then indicate when a ticking watch is heard as the nurse brings the watch closer to the client's ear

Correct answer: D

Rationale: To test the cochlear portion of the acoustic nerve (cranial nerve VIII), the nurse should have the client close their eyes and indicate when a ticking watch is heard as the nurse moves the watch closer to the client's ear. This action assesses the client's ability to perceive auditory stimuli, as the cochlear portion of the acoustic nerve is responsible for hearing. Choices A, B, and C are incorrect. Asking the client to raise their eyebrows to check for symmetry is a method to test the facial nerve (cranial nerve VII). Asking the client to clench their teeth and palpating the masseter muscles tests the motor component of the trigeminal nerve. Having the client identify light and sharp touch on both sides of the face is a way to test the sensory component of the trigeminal nerve (cranial nerve V).

3. The LPN is caring for a client admitted for acute pancreatitis. Which of these medications would be the least appropriate for pain management?

• A. Tylenol
• B. Tramadol
• C. Codeine
• D. Morphine

Correct answer: D

Rationale: Morphine is the least appropriate choice for pain management in pancreatitis due to its potential to cause spasms in the Sphincter of Oddi, which can worsen the client's condition by potentially obstructing the pancreatic duct. Tylenol, Tramadol, and Codeine are more suitable options for pain management in acute pancreatitis as they do not carry the same risk of exacerbating the condition by causing spasms in the Sphincter of Oddi.

4. How often should the intravenous tubing on total parenteral nutrition solutions be changed?

• A. every 24 hours
• B. every 36 hours
• C. every 48 hours
• D. every 72 hours

Correct answer: A

Rationale: The correct answer is to change the intravenous tubing on total parenteral nutrition solutions every 24 hours. This frequency is necessary due to the high risk of bacterial growth associated with TPN solutions. Changing the tubing every 24 hours helps prevent contamination and bloodstream infections. Choices B, C, and D are incorrect because waiting longer intervals increases the risk of introducing harmful bacteria into the patient's system, leading to potentially severe complications.

5. The mother of an adolescent calls the clinic nurse and reports that her daughter wants to have her navel pierced. The mother asks the nurse about the dangers associated with body piercing. The nurse provides which information to the mother?

• A. Infection always occurs when body piercing is done
• B. Hepatitis B is a concern with body piercing
• C. Body piercing is generally harmless as long as it is performed under sterile conditions
• D. It is important to discourage body piercing because of the risk of contracting human immunodeficiency virus (HIV)

Correct answer: C

Rationale: Generally, body piercing is harmless if the procedure is performed under sterile conditions by a qualified person. Some complications that may occur include bleeding, infection, keloid formation, and the development of allergies to metal. It is essential to clean the area at least twice a day (more often for a tongue piercing) to prevent infection. HIV and hepatitis B infections are not typically associated with body piercing; however, they are a possibility with tattooing. Choice A is incorrect because infection does not always occur when body piercing is done. Choice B is not the best answer as hepatitis B is not commonly associated with body piercing. Choice D is incorrect because the risk of contracting HIV is not a significant concern with body piercing if performed under sterile conditions.

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