Nursing Elites

1. After a 26-year-old gravida 4, para 0 experienced a spontaneous abortion at 9 weeks gestation, how should the nurse intervene after observing the client crying softly one hour post dilation and curettage (D&C)?

• A. Offer to call the social worker to discuss the possibility of adoption
• B. Reassure the client that the infertility specialist can help
• C. Express sorrow for the client's grief and offer to sit with her
• D. Chart the vital signs and amount of vaginal bleeding

Correct answer: C

Rationale: After a traumatic experience like a spontaneous abortion, it is crucial for the nurse to provide emotional support. Expressing sorrow for the client's grief and offering to sit with her demonstrates empathy and allows the client to process her emotions. Options A and B focus on future possibilities and medical interventions, which may not be immediately appropriate. Option D, while important for monitoring the client's physical status, does not address the client's emotional needs at that moment.

2. The practical nurse is preparing to administer a prescription for cefazolin (Kefzol) 600 mg IM every six hours. The available vial is labeled, 'Cefazolin (Kefzol) 1 gram,' and the instructions for reconstitution state, 'For IM use add 2 ml sterile water for injection. Total volume after reconstitution = 2.5 ml.' When reconstituted, how many milligrams are in each milliliter of solution?

• A. 400 mg/mL
• B. 500 mg/mL
• C. 450 mg/mL
• D. 350 mg/mL

Correct answer: A

Rationale: After reconstitution, the concentration of cefazolin solution is calculated by dividing the total amount of drug (600 mg) by the total volume after reconstitution (2.5 mL). This gives 600 mg / 2.5 mL = 240 mg/mL. However, the question asks for the concentration in each milliliter of solution after reconstitution, so we need to consider the final volume of 2.5 mL. Therefore, 240 mg/mL * 2.5 mL = 600 mg, which means each milliliter contains 240 mg of cefazolin. Therefore, after reconstitution, there are 400 mg of cefazolin in each milliliter of solution. Choices B, C, and D are incorrect as they do not accurately reflect the concentration after reconstitution.

3. Which client assessment falls within the scope of practice for the practical nurse?

• A. An agitated client with bilateral wrist restraints
• B. New admission of a client with deep vein thrombosis
• C. Return of a post-anesthesia client following a colon resection
• D. Transfer of a client with sepsis from a long-term care facility

Correct answer: B

Rationale: The correct answer is B because assessing a new deep vein thrombosis (DVT) patient is within the scope of practical nursing. It involves monitoring and supporting the circulatory system health, which is a common responsibility for practical nurses. Choices A, C, and D involve scenarios that are typically beyond the initial assessment and care provided by practical nurses. An agitated client with bilateral wrist restraints may require immediate intervention by higher-level healthcare providers due to safety concerns and potential underlying issues. The return of a post-anesthesia client following a colon resection and the transfer of a client with sepsis involve more specialized care that goes beyond the typical responsibilities of a practical nurse, often requiring interventions from registered nurses or physicians.

4. A client with a diagnosis of bipolar disorder is taking lithium. What is the most important information the nurse should provide?

• A. Take the medication on an empty stomach
• B. Monitor sodium intake
• C. Report any signs of weight gain
• D. Avoid excessive caffeine intake

Correct answer: B

Rationale: The correct answer is B. Sodium levels can affect lithium levels in the body, so it is crucial to monitor sodium intake to prevent toxicity or subtherapeutic levels. Lithium is typically taken on an empty stomach to enhance absorption, making choice A more accurate than the original 'Take the medication with food.' Reporting weight gain, as mentioned in choice C, is important for monitoring side effects but is not as critical as ensuring proper lithium levels through sodium intake monitoring. Choice D, avoiding excessive caffeine intake, is not a priority concern directly related to lithium therapy.

5. The client with diabetes is being taught about the importance of foot care. Which statement by the client indicates a need for further teaching?

• A. ''I will inspect my feet daily for any cuts or blisters.''
• B. ''I will soak my feet in warm water every day.''
• C. ''I will wear shoes that fit properly to avoid injury.''
• D. ''I will avoid walking barefoot to protect my feet.''

Correct answer: B

Rationale: Choice B is the correct answer because soaking feet daily can lead to skin breakdown, making it inappropriate for clients with diabetes. Inspecting feet daily for cuts or blisters (Choice A), wearing properly fitting shoes (Choice C), and avoiding walking barefoot (Choice D) are all appropriate measures to maintain foot health for clients with diabetes.

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