Nursing Elites

1. The nurse observes bilateral bruises on the arms of an elderly client in a long-term care facility. Which of the following questions should the nurse ask this client?

• A. "How did you get those bruises?"?
• B. "Did someone grab you by your arms?"?
• C. "Do you fall often?"?
• D. "What did you bump against?"?

Correct answer: B

Rationale: The correct answer is asking, "Did someone grab you by your arms?"? This question is direct and addresses the possibility of abuse, which is crucial when dealing with suspected abuse cases. It is important to ask direct questions in a sensitive and non-accusatory manner to gather information. Choice A is too general and may not prompt a disclosure of abuse. Choice C assumes falling as the cause without addressing abuse directly. Choice D is vague and does not specifically inquire about potential abuse, making it less effective in identifying abuse cases compared to the correct choice.

2. A health care worker is concerned about a new mother being overwhelmed by caring for her infant. What should the health care worker do?

• A. Immediately contact child protective services.
• B. Provide the mother with literature about child care.
• C. Consult a therapist to help the mother work out her fears.
• D. Refer the mother to parenting classes.

Correct answer: D

Rationale: When a health care worker is concerned about a new mother being overwhelmed by caring for her infant, the best course of action is to refer the mother to parenting classes. Prevention of child abuse is focused on educating parents on how to care for their child and handle the demands of infant care. By attending parenting classes, the mother can build self-confidence, self-esteem, and coping skills. Parenting classes help parents understand the developmental needs of their children and learn effective ways to manage their home environment. Additionally, these classes provide parents with increased social contacts and knowledge about community resources. Contacting child protective services (choice A) should not be the immediate action as there is no indication of abuse. Providing literature about child care (choice B) may not be as effective as hands-on parenting classes. Consulting a therapist (choice C) may be beneficial, but addressing parenting skills through classes is more appropriate in this scenario.

3. While the client is receiving total parenteral nutrition (TPN), which lab test should be evaluated?

• A. Hemoglobin
• B. Creatinine
• C. Blood glucose
• D. White blood cell count

Correct answer: C

Rationale: When a client is receiving total parenteral nutrition (TPN), monitoring blood glucose levels is crucial as TPN solutions contain high amounts of glucose. This monitoring helps prevent hyperglycemia or hypoglycemia. Evaluating hemoglobin (choice A) is not directly related to TPN administration. Creatinine (choice B) is more relevant for assessing kidney function. White blood cell count (choice D) is important for evaluating immune function and infection, but not specifically tied to TPN administration.

4. A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that:

• A. the client's body has developed tolerance, requiring more drug to produce the same effect
• B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence
• C. addiction involves psychological behaviors related to substance use, not just physical dependence
• D. the client is coping with chronic back pain and requires adjustments in the medication regimen

Correct answer: A

Rationale: When a client requires an increased dose of a drug, such as in this case with hydrocodone, it suggests that the body has developed tolerance to the medication. Tolerance means that the client needs more of the drug to achieve the same effect as before. This does not inherently indicate addiction, which involves psychological behaviors related to substance use. Choice B describes drug dependence, where the client is preoccupied with obtaining the drug and experiences loss of control, which is not the same as tolerance. Choice C correctly points out that addiction is more than just physical dependence with withdrawal symptoms and tolerance; it includes psychological factors. Choice D is irrelevant as it discusses adjusting the medication for pain management, not addressing the client's concern about addiction.

5. Referral for client education in the community can be accomplished through all of the following except:

• A. community agencies such as the American Heart Association
• B. parish nurses
• C. home health care agencies
• D. unlicensed massage therapists

Correct answer: D

Rationale: Client education should be conducted by individuals with acknowledged expertise in the subject area and appropriate credentials to support their activities within the healthcare community. Choices A, B, and C involve reputable entities or professionals who can provide accurate and reliable client education. The American Heart Association, parish nurses, and home health care agencies are recognized for their healthcare-related knowledge and qualifications. However, unlicensed massage therapists lack the necessary qualifications and expertise to deliver appropriate healthcare-related education, making them unsuitable for referrals when it comes to client education in the community.

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