Nursing Elites

1. A charge nurse is explaining the various stages of the lifespan to a group of newly licensed nurses. Which of the following examples should the nurse include as a developmental task for middle adulthood?

• A. The client evaluates their behavior after a social interaction.
• B. The client states they are learning to trust others.
• C. The client wishes to find meaningful friendships.
• D. The client expresses concerns about the next generations.

Correct answer: D

Rationale: The correct answer is D because in middle adulthood, individuals often shift their focus towards concerns related to the next generations. They reflect on their roles in guiding and supporting the younger generations. Choice A is incorrect as evaluating behavior after a social interaction is more relevant to self-awareness, which is not a specific developmental task for middle adulthood. Choice B, learning to trust others, is more commonly associated with early adulthood tasks related to forming intimate relationships. Choice C, wishing to find meaningful friendships, is more aligned with tasks associated with young adulthood and social connections.

2. A client who has a new prescription for warfarin (Coumadin) is receiving discharge instructions. Which statement indicates the client understands the teaching?

• A. I will take my warfarin at the same time every day.
• B. I should increase my intake of green leafy vegetables.
• C. I should use a soft-bristled toothbrush while taking this medication.
• D. I should avoid drinking alcohol while taking this medication.

Correct answer: C

Rationale: The correct answer is C: 'I should use a soft-bristled toothbrush while taking this medication.' Using a soft-bristled toothbrush is crucial as it helps prevent bleeding gums, which is a potential side effect of warfarin therapy. Option A about taking warfarin at the same time every day is a good practice but does not directly relate to preventing side effects. Option B suggesting an increase in green leafy vegetables can interfere with warfarin's anticoagulant effects due to their vitamin K content. Option D advising to avoid alcohol is generally recommended but is not directly related to the specific side effects of warfarin.

3. The healthcare provider is assessing a 17-month-old with acetaminophen poisoning. Which lab reports should the provider review first?

• A. Prothrombin time (PT) and partial thromboplastin time (PTT)
• B. Red blood cell and white blood cell counts
• C. Blood urea nitrogen and creatinine levels
• D. Liver enzymes (AST and ALT)

Correct answer: D

Rationale: In acetaminophen poisoning, liver damage is a significant concern due to the potential for hepatotoxicity. Therefore, the healthcare provider should first review liver enzymes such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase) to assess liver function. Prothrombin time and partial thromboplastin time are coagulation studies and are not the priority in acetaminophen poisoning. Red blood cell and white blood cell counts are important in assessing for anemia or infection but are not specific to acetaminophen poisoning. Blood urea nitrogen and creatinine levels primarily assess kidney function, which is not the primary concern in acetaminophen poisoning.

4. When planning home care for a 72-year-old client with osteomyelitis requiring a 6-week course of intravenous antibiotics, what is the most important action by the nurse?

• A. Investigating the client's insurance coverage for home IV antibiotic therapy
• B. Determining if there are adequate hand washing facilities in the home
• C. Assessing the client's ability to participate in self-care and/or the reliability of a caregiver
• D. Selecting the appropriate venous access device

Correct answer: C

Rationale: Assessing the client's ability to participate in self-care or evaluating the reliability of a caregiver is crucial in ensuring adherence to the treatment plan. This action helps determine if the client can manage the intravenous antibiotics at home independently or if assistance is needed. Investigating insurance coverage, ensuring hand washing facilities, and selecting the venous access device are important aspects of care but assessing the client's ability for self-care and caregiver reliability takes precedence to promote treatment success and safety.

5. The healthcare professional is caring for a client who is post-operative following a hip replacement. Which assessment finding would require immediate intervention?

• A. Pain at the surgical site
• B. Swelling in the affected leg
• C. Elevated temperature
• D. Shortness of breath

Correct answer: D

Rationale: Shortness of breath is a critical assessment finding that could indicate a pulmonary embolism or other serious complication related to surgery, such as a respiratory issue or cardiac problem. Immediate intervention is necessary to prevent further complications or harm to the client. Pain at the surgical site is common post-operatively and can be managed with appropriate pain relief measures. Swelling in the affected leg is expected after a hip replacement and can often be managed conservatively or monitored closely. An elevated temperature could be a sign of infection, which is important to address but may not require immediate intervention unless other symptoms of sepsis are present.

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