Nursing Elites

1. A 60-year-old female client with a positive family history of ovarian cancer has developed an abdominal mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear results are negative. What information should the nurse include in the client's teaching plan?

• A. Further evaluation involving surgery may be needed
• B. A pelvic exam is also needed before cancer is ruled out
• C. Pap smear evaluation should be continued every six months
• D. One additional negative Pap smear in six months is needed

Correct answer: A

Rationale: In a 60-year-old female client with a family history of ovarian cancer and an abdominal mass, further evaluation involving surgery may be needed to rule out ovarian cancer. The presence of an abdominal mass raises suspicion for a possible malignancy, and a negative Pap smear result does not rule out ovarian cancer. A pelvic exam alone may not provide sufficient information to confirm or rule out ovarian cancer. Continuing Pap smear evaluations every six months or waiting for one additional negative Pap smear in six months is not appropriate in this scenario, as the abdominal mass requires immediate attention and further evaluation.

2. A client who received multiple antihypertensive medications experiences syncope due to a drop in blood pressure to 70/40. What is the rationale for the nurse's decision to hold the client's scheduled antihypertensive medication?

• A. Increased urinary clearance of the multiple medications has produced diuresis and lowered the blood pressure
• B. The antagonistic interaction among the various blood pressure medications has reduced their effectiveness
• C. The additive effect of multiple medications has caused the blood pressure to drop too low.
• D. The synergistic effect of the multiple medications has resulted in drug toxicity and resulting hypotension.

Correct answer: C

Rationale: When medications with a similar action are administered, an additive effect occurs that is the sum of the effects of each medication. In this case, several medications that all lower blood pressure, when administered together, resulted in hypotension.

3. The healthcare provider prescribes ceftazidime (Fortaz) 35 mg every 8 hours IM for an infant. The 500 mg vial is labeled with the instruction to add 5.3 ml diluent to provide a concentration of 100 mg/ml. How many ml should the nurse administer for each dose?

• A. 0.35 ml
• B. 0.40 ml
• C. 0.50 ml
• D. 0.45 ml

Correct answer: B

Rationale: To calculate the volume to be administered for 35 mg of ceftazidime, divide the prescribed dose by the concentration: 35 mg / 100 mg/ml = 0.35 ml. Rounding off, the nurse should administer 0.4 ml for each dose. Choice A is incorrect as it doesn't consider rounding off. Choice C is incorrect because it's not the correct calculation. Choice D is incorrect as it doesn't reflect the accurate volume needed.

4. While removing staples from a male client's postoperative wound site, the nurse observes that the client's eyes are closed and his face and hands are clenched. The client states, 'I just hate having staples removed.' After acknowledging the client's anxiety, what action should the nurse implement?

• A. Attempt to distract the client with general conversation
• B. Administer a pain medication
• C. Continue with the procedure while reassuring the client
• D. Stop the procedure and notify the healthcare provider

Correct answer: A

Rationale: In this situation, the nurse should attempt to distract the client with general conversation. Distracting the client can help reduce anxiety and make the procedure less stressful. Administering pain medication (choice B) is not appropriate as the client's discomfort is related to anxiety, not physical pain. Continuing with the procedure while reassuring the client (choice C) may not address the client's anxiety effectively. Stopping the procedure and notifying the healthcare provider (choice D) is not necessary at this point since the client's anxiety can be managed by attempting to distract him.

5. A client with hypertension receives a prescription for enalapril, an angiotensin-converting enzyme (ACE) inhibitor. Which instruction should the nurse include in the medication teaching plan?

• A. Increase intake of potassium-rich foods.
• B. Report increased bruising or bleeding.
• C. Stop medication if a cough develops.
• D. Limit intake of leafy green vegetables.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the medication teaching plan is to 'Report increased bruising or bleeding.' ACE inhibitors can cause thrombocytopenia, which lowers platelet count and increases the risk of bruising and bleeding. Choice A is incorrect because while ACE inhibitors may cause potassium levels to increase, the instruction should not be to increase intake of potassium-rich foods without healthcare provider guidance. Choice C is incorrect because a cough is a common side effect of ACE inhibitors due to bradykinin accumulation, and stopping the medication abruptly is not recommended without consulting the healthcare provider. Choice D is incorrect because there is no need to limit intake of leafy green vegetables specifically with ACE inhibitors; however, consistent intake of vitamin K-rich foods is recommended to maintain a stable INR for clients taking anticoagulants.

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