Nursing Elites

1. What should the charge nurse do after overhearing the patient care assistant speaking harshly to the client with dementia?

• A. Change the patient care assistant's assignment
• B. Explore the interaction with the patient care assistant
• C. Discuss the matter with the client's family
• D. Initiate a group session with the patient care assistant

Correct answer: B

Rationale: The best action for the charge nurse to take is to explore the interaction with the patient care assistant. This step allows for clarification of the situation and direct addressing of the issue. Changing the patient care assistant's assignment (choice A) might be necessary, but understanding the situation should come first. Discussing the matter with the client's family (choice C) as an initial step could escalate the situation. Initiating a group session with the patient care assistant (choice D) could be considered later as a preventive measure to avoid similar incidents in the future.

2. How can the nurse best communicate to a client that he or she has been listening?

• A. restating the main feeling or thought the client has expressed
• B. making a judgment about the client's problem
• C. offering a leading question such as, 'And then what happened?'
• D. saying, 'I understand what you're saying.'

Correct answer: A

Rationale: The best way for the nurse to communicate to a client that he or she has been listening is by restating the main feeling or thought the client has expressed. Restating helps the client validate the nurse's understanding of the communication, demonstrating active listening skills. Making judgments about the client's problem, as suggested in Choice B, can hinder effective communication by introducing bias and potential misinterpretation. Offering a leading question like in Choice C is not ideal for confirming understanding; it rather seeks more information. Choice D, simply saying 'I understand what you're saying,' may not convey active listening as effectively as restating the client's main feelings or thoughts, as it lacks the validation component present in restating.

3. How should Lasix be administered to prevent hypotension?

• A. By administering it over 1-2 minutes
• B. By hanging it IV piggyback
• C. With normal saline only
• D. By administering it through a venous access device

Correct answer: A

Rationale: Lasix should be administered over 1-2 minutes at approximately 1mL per minute to prevent hypotension. This slow administration helps to reduce the risk of adverse effects such as sudden drops in blood pressure. Choice B is incorrect because Lasix does not need to be hung IV piggyback, choice C is incorrect as Lasix administration does not require it to be mixed with normal saline only, and choice D is incorrect as Lasix does not have to be specifically administered through a venous access device (VAD) to prevent hypotension.

4. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:

• A. cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.
• B. have few, if any, side effects.
• C. are used to treat multiple types of cancer.
• D. are cell-cycle-specific agents.

Correct answer: A

Rationale: Alkylating agents, such as nitrogen mustards, are effective chemotherapeutic agents because they cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. This cross-linking interferes with DNA replication and transcription, leading to cell death. Choice B is incorrect because alkylating agents have numerous side effects, including alopecia, nausea, vomiting, and myelosuppression. Choice C is incorrect because while nitrogen mustards are used to treat multiple types of cancer like chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and breast and ovarian cancer, their effectiveness is primarily due to DNA cross-linkage. Choice D is incorrect because alkylating agents are non-cell-cycle-specific agents, meaning they can act on cells in any phase of the cell cycle, not just on cells that are actively dividing.

5. A woman asks, "How much alcohol can I safely drink while pregnant?"? The nurse's best response is:

• A. "The amount of alcohol that is safe during pregnancy is unknown."?
• B. "Consuming one or two beers or glasses of wine a day is considered safe for a healthy pregnant woman."?
• C. "Drinking three or more drinks on any given occasion is the only harmful type of drinking during pregnancy."?
• D. "You can have a drink to help you relax and get to sleep at night."?

Correct answer: A

Rationale: The correct answer is, "The amount of alcohol that is safe during pregnancy is unknown."? It is crucial for pregnant women to avoid alcohol as there is no known safe amount during pregnancy. Consuming any amount of alcohol can harm the developing fetus and increase the risk of fetal alcohol syndrome, a condition characterized by mental and physical abnormalities in infants. Choices B, C, and D are incorrect because they provide misleading information that can potentially harm the fetus. Pregnant women should abstain from alcohol to ensure the health and well-being of their baby.

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