Nursing Elites

1. A contraindication for topical corticosteroid use in a client with atopic dermatitis (eczema) is:

• A. parasitic infection
• B. fungal infection
• C. spirochetal infection
• D. viral infection

Correct answer: D

Rationale: Topical corticosteroids are mainly used for their localized effects. When treating atopic dermatitis with a steroidal preparation, there is a risk of the site being vulnerable to invasion by organisms. Viruses like herpes simplex or varicella zoster pose a threat of disseminated infection. Therefore, viral infection is a contraindication for topical corticosteroid use in clients with atopic dermatitis. It is crucial to educate clients using topical corticosteroids to avoid crowds or people with infections and to promptly report any signs of infection. Choices A, B, and C (parasitic, fungal, and spirochetal infections) are not typically contraindications for topical corticosteroid use in the context of atopic dermatitis, as these agents do not pose the same risk of disseminated infection or systemic effects as viral infections.

2. The physician has prescribed tranylcypromine sulfate (Parnate) 10mg bid. The nurse should teach the client to refrain from eating foods containing tyramine because it may cause:

• A. Hypertension
• B. Hyperthermia
• C. Melanoma
• D. Urinary retention

Correct answer: A

Rationale: If the client eats foods high in tyramine, he might experience malignant hypertension. Tyramine is found in cheese, sour cream, Chianti wine, sherry, beer, pickled herring, liver, canned figs, raisins, bananas, avocados, chocolate, soy sauce, fava beans, and yeast. These episodes are treated with Regitine, an alpha-adrenergic blocking agent. Choices B, C, and D are unrelated to the question: Hyperthermia is excessive body temperature, melanoma is a type of skin cancer, and urinary retention is the inability to empty the bladder.

3. The client is diagnosed with multiple myeloma. The doctor has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the client?

• A. "Walk about a mile a day to prevent calcium loss."?
• B. "Increase the fiber in your diet."?
• C. "Report nausea to the doctor immediately."?
• D. "Drink at least eight large glasses of water a day."?

Correct answer: D

Rationale: Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis, a condition characterized by inflammation of the bladder wall leading to bleeding. To prevent this complication, the client should drink at least eight glasses of water a day. Walking to prevent calcium loss (choice A) and increasing fiber intake (choice B) are not directly related to the side effects of Cytoxan, making them unnecessary instructions in this case. While nausea is a common side effect of chemotherapy, the immediate reporting of nausea to the doctor (choice C) is important but not specifically related to the use of Cytoxan in this scenario.

4. A nurse notes that an elderly client suddenly does not keep appointments and is not wearing appropriate clothing. Which statement by the client raises the suspicion of financial abuse?

• A. "I am having difficulty paying for this new antibiotic the physician prescribed."?
• B. "I am a little short on cash since my daughter moved in to help me."?
• C. "I have not felt like shopping since the weather has gotten worse."?
• D. "People do not realize how difficult it is to make ends meet on a fixed income."?

Correct answer: B

Rationale: The correct answer is B: "I am a little short on cash since my daughter moved in to help me."? This statement raises suspicion of financial abuse as it suggests a recent change in financial circumstances after the daughter moved in. Financial abuse in elderly clients can be indicated by sudden unexplained financial deficits or changes, such as difficulty paying for necessities despite previously being able to do so. Choices A, C, and D do not directly imply a recent financial change due to external factors, making them less indicative of potential financial abuse. Option B is the most concerning statement that warrants further investigation into possible financial exploitation.

5. A mother has just given birth to a baby who died soon after. The mother has been crying and states, "I can't believe this has happened to me. I did everything right during this pregnancy."? How should the nurse respond to this mother?

• A. Tell her she did nothing wrong; it was God's will.
• B. Tell her she can have another baby.
• C. Tell her that her behavior is not going to solve anything.
• D. Tell her nothing and let her mourn this loss in the manner she chooses.

Correct answer: D

Rationale: Perinatal loss is a significant tragedy for parents, and it is crucial to provide sensitive and compassionate care. When a mother expresses her disbelief and feelings of doing everything right during the pregnancy, it is important for the nurse to acknowledge her pain and allow her to grieve in her way. Telling her that she did nothing wrong and it was God's will (Choice A) may not be comforting and can come across as dismissive of her feelings. Suggesting she can have another baby (Choice B) is insensitive and overlooks the grief she is experiencing for the current loss. Telling her that her behavior is not going to solve anything (Choice C) is invalidating her emotions and not supportive in this situation. Therefore, the best approach is to support her in her mourning process by respecting her feelings and allowing her to express her grief as she sees fit.

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