Nursing Elites

1. A client is undergoing chemotherapy and is at risk for developing thrombocytopenia. What precaution should the nurse teach the client to minimize the risk of bleeding?

• A. Use a soft-bristled toothbrush.
• B. Engage in daily aerobic exercise.
• C. Take aspirin for headaches.
• D. Use an electric razor for shaving.

Correct answer: A

Rationale: Using a soft-bristled toothbrush is essential for clients at risk of thrombocytopenia to prevent gum bleeding, as their platelet counts may be low. Vigorous brushing with a hard-bristled toothbrush can injure the gums, leading to bleeding, which can be exacerbated in clients with low platelets. Therefore, advising the client to use a soft-bristled toothbrush is a crucial precaution to minimize the risk of bleeding.

2. A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Diverticulitis

Correct answer: A

Rationale: The constellation of symptoms including abdominal pain, diarrhea, and rectal bleeding in a young woman with a history of similar episodes is highly suggestive of ulcerative colitis. This chronic inflammatory condition primarily affects the colon and rectum, leading to symptoms such as bloody diarrhea, abdominal pain, and urgency. The recurrent nature of her symptoms and the presence of rectal bleeding further support this diagnosis over other conditions listed, such as irritable bowel syndrome, celiac disease, or diverticulitis, which typically do not present with the same combination of symptoms and history.

3. A client with a history of chronic alcohol use is admitted with confusion and an unsteady gait. Which deficiency should the nurse suspect?

• A. Thiamine (Vitamin B1)
• B. Cyanocobalamin (Vitamin B12)
• C. Folic acid
• D. Vitamin D

Correct answer: A

Rationale: The correct answer is Thiamine (Vitamin B1). Chronic alcohol use can lead to thiamine deficiency, which can result in neurological symptoms such as confusion and an unsteady gait. Thiamine is essential for proper brain function and nerve conduction, and its deficiency is common in individuals with alcohol use disorder. Cyanocobalamin (Vitamin B12) deficiency can also present with neurological symptoms, but in this case, the patient's history of chronic alcohol use points more towards thiamine deficiency. Folic acid deficiency typically presents with symptoms like fatigue and megaloblastic anemia. Vitamin D deficiency is associated with bone health issues rather than neurological symptoms.

4. During the initial assessment of a client with a history of substance abuse admitted for detoxification, which intervention is most important?

• A. Obtain a detailed substance use history.
• B. Establish a trusting nurse-client relationship.
• C. Evaluate the client's physical health status.
• D. Determine the client's readiness for change.

Correct answer: C

Rationale: Assessing the client's physical health status is the most critical intervention during the initial assessment of a client with a history of substance abuse admitted for detoxification. This evaluation helps identify and address any immediate health risks, such as withdrawal symptoms or medical complications, to ensure the client's safety and well-being during the detoxification process. Option A, obtaining a detailed substance use history, is important but not the most critical initially. Option B, establishing a trusting nurse-client relationship, is important but assessing physical health takes precedence. Option D, determining the client's readiness for change, is valuable but assessing physical health for immediate risks is the priority.

5. A client with newly diagnosed hypertension is prescribed enalapril (Vasotec). Which instruction should the nurse provide to the client?

• A. Increase your intake of potassium-rich foods.
• B. Report any persistent cough to your healthcare provider.
• C. Take the medication with a full meal.
• D. Avoid grapefruit juice while taking this medication.

Correct answer: B

Rationale: The correct instruction for the nurse to provide the client taking enalapril (Vasotec) is to report any persistent cough to their healthcare provider. Enalapril can cause a side effect of a persistent cough, and it is essential for the healthcare provider to be notified if this occurs to evaluate the need for a medication adjustment or change. Choices A, C, and D are incorrect. Increasing potassium-rich foods is not specifically related to enalapril use; there is no requirement to take enalapril with a full meal, and avoiding grapefruit juice is more relevant for medications metabolized by the CYP3A4 enzyme, not typically for enalapril.

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