Nursing Elites

1. How can a nurse best help a client undergoing a bone marrow aspiration and biopsy, along with two upset family members, manage anxiety during the procedure?

• A. Allow the client's family to stay for emotional support.
• B. Accompany the client silently.
• C. Encourage the client to take slow, deep breaths to promote relaxation.
• D. Provide the client an opportunity to verbalize emotions.

Correct answer: C

Rationale: Encouraging the client to take slow, deep breaths is an effective way for the nurse to help the client manage anxiety during the bone marrow aspiration and biopsy procedure. Slow, deep breathing can promote relaxation and help reduce anxiety levels. Choice A, allowing the client's family to stay for emotional support, may provide comfort but does not address a direct intervention to help manage anxiety. Choice B, staying with the client silently, may not actively help the client address their anxiety. Choice D, allowing the client to express feelings, is important but may not directly address anxiety management during the procedure.

2. A serum phenytoin determination is prescribed for a client with a seizure disorder who is taking phenytoin (Dilantin). Which result indicates that the prescribed dose of phenytoin is therapeutic?

• A. 3 mcg/mL
• B. 8 mcg/mL
• C. 16 mcg/mL
• D. 28 mcg/mL

Correct answer: C

Rationale: The correct answer is 16 mcg/mL (Choice C). The therapeutic serum phenytoin range is typically 10 to 20 mcg/mL. A level below this range may lead to continued seizure activity, indicating subtherapeutic levels. Choices A, B, and D are below the therapeutic range and would not be considered therapeutic for a client with a seizure disorder on phenytoin therapy.

3. The healthcare provider is assessing a client with chronic renal failure who is receiving hemodialysis. Which of the following findings would indicate a complication of the treatment?

• A. Temperature of 98.6°F (37°C).
• B. Weight gain of 2 lbs (0.9 kg) since the last treatment.
• C. Blood pressure of 130/80 mm Hg.
• D. Pulse rate of 72 bpm.

Correct answer: B

Rationale: Weight gain between dialysis sessions can indicate fluid overload, a common complication in clients with chronic renal failure. This can lead to complications such as hypertension, pulmonary edema, and heart failure. A normal temperature, blood pressure, and pulse rate are expected findings in this scenario and would not typically indicate a complication of hemodialysis treatment.

4. The client is being taught about the best time to plan sexual intercourse in order to conceive. Which information should be provided?

• A. Two weeks before menstruation.
• B. Vaginal mucous discharge is thick.
• C. Low basal temperature.
• D. First thing in the morning.

Correct answer: A

Rationale: The correct answer is A: 'Two weeks before menstruation.' Ovulation typically occurs 14 days before menstruation begins during a typical 28-day cycle. To increase the chances of conception, sexual intercourse should occur within 24 hours of ovulation. High estrogen levels during ovulation lead to changes in vaginal mucous discharge, making it more 'slippery' and stretchy. Basal temperature rises during ovulation. The timing of intercourse during the day is less significant than ensuring it happens around ovulation. The other options are incorrect because planning intercourse two weeks before menstruation is likely to miss the fertile window, thick vaginal mucous discharge indicates ovulation is approaching, and low basal temperature is not indicative of the fertile period.

5. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?

• A. Decreased urine output
• B. Improved blood oxygenation
• C. Increased interstitial fluid
• D. Stabilization of heart rate and blood pressure

Correct answer: D

Rationale: 6% Dextran 75 is a high molecular-weight colloidal solution used to treat shock from burns or trauma. Colloids like 6% dextran 75 are plasma expanders that help increase blood volume, leading to improved heart rate and blood pressure stabilization. The infusion of plasma expanders does not typically decrease urine output. It primarily aims to stabilize circulation rather than affect blood oxygenation or increase interstitial fluid levels.

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