Nursing Elites

1. A client is leaving the hospital against medical advice (AMA) and voluntarily signs the AMA form. Which nursing action is essential prior to the client leaving?

• A. Remove the client's peripheral IV access
• B. Administer requested pain relief medication
• C. Obtain the client's neurological vital signs
• D. Provide the client with the hospital's phone number

Correct answer: A

Rationale: Removing the client's peripheral IV access is essential before the client leaves against medical advice to prevent complications such as infection, thrombosis, or bleeding. Administering pain relief medication (choice B) can be important but not essential at this point. Obtaining neurological vital signs (choice C) is not specifically required before the client leaves. Providing the client with the hospital's phone number (choice D) may be helpful but is not as essential as ensuring the safe removal of IV access.

2. A client who is bleeding after a vaginal delivery receives a prescription for methylergonovine (Methergine) 0.4 mg IM every 2 hours, not to exceed 5 doses. The medication is available in ampules containing 0.2 mg/ml. What is the maximum dosage in mg that the nurse should administer to this client?

• A. Encourage oral fluids as tolerated
• B. Decrease oral intake to 200 ml
• C. Allow the client to have exactly 400 ml oral intake
• D. Limit oral intake to 900 to 1,000 ml

Correct answer: D

Rationale: The maximum dosage the nurse should administer is 2 mg. This is calculated based on the prescription of 0.4 mg IM every 2 hours, not to exceed 5 doses. Since the medication is available in ampules containing 0.2 mg/ml, the nurse should administer 2 ml (0.2 mg/ml x 10 ml) for each dose, not exceeding 5 doses. Therefore, the nurse should limit the client's oral intake to 900 to 1,000 ml, to avoid exceeding the maximum dosage of 2 mg.

3. A healthcare provider is assessing a client who is receiving treatment for dehydration. Which assessment finding indicates that the client is responding to the treatment?

• A. Dry mucous membranes
• B. Increased urine output
• C. Decreased skin turgor
• D. Elevated heart rate

Correct answer: B

Rationale: Increased urine output is a positive sign indicating that the client is responding to the treatment for dehydration. It suggests that the client's kidneys are functioning better, helping to eliminate excess fluid and waste products from the body. Dry mucous membranes (Choice A) are a sign of dehydration, not improvement. Decreased skin turgor (Choice C) and elevated heart rate (Choice D) are also symptoms of dehydration and do not indicate a positive response to treatment.

4. A male client is admitted to the mental health unit because he experiences panic attacks when driving on the freeway. To attempt to desensitize this fear, what action should the nurse encourage the client to implement?

• A. Watch training videos of people driving in various environments
• B. Begin visualizing himself driving each route to the freeway
• C. Take antianxiety medication two hours before driving on freeways
• D. Get in the car with a support person and drive on a freeway during rush hour

Correct answer: B

Rationale: Visualization techniques, such as visualizing himself driving each route to the freeway, are commonly used in desensitization therapy to help clients gradually overcome their fears. Watching videos of others driving or taking medication do not actively involve the client in facing their fear, which is essential in desensitization therapy. Getting in the car with a support person during rush hour may exacerbate the client's anxiety rather than help in desensitization.

5. The husband and adult children of a woman who abuses alcohol ask the nurse what approach to use when her drinking behavior disrupts family plans. Which response is best for the nurse to provide?

• A. Destroy any hidden supplies of alcohol she has at home so she has to stay sober
• B. When she drinks, communicate how disruptive her behaviors are and the burden they inflict on the family
• C. Make her responsible for the consequences of her drinking behaviors
• D. Include her in family activities whether she is drinking or sober

Correct answer: C

Rationale: The best approach for the nurse to suggest is to make the woman responsible for the consequences of her drinking behaviors. By holding her accountable, she is more likely to recognize the impact of her actions and potentially initiate change. Destroying hidden alcohol supplies (Choice A) might lead to conflict and further secretive behavior. Simply communicating the disruptions caused by her drinking (Choice B) may not effectively address the issue. Including her in family activities regardless of her drinking status (Choice D) could enable the behavior and not address the underlying problem.

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