Nursing Elites

1. A client with a diagnosis of osteoporosis is prescribed alendronate (Fosamax). What is the most important instruction the nurse should provide?

• A. Take the medication in the morning on an empty stomach.
• B. Take the medication at bedtime.
• C. Remain upright for at least 30 minutes after taking the medication.
• D. Take the medication with a full glass of water.

Correct answer: D

Rationale: The most important instruction the nurse should provide to a client prescribed alendronate (Fosamax) for osteoporosis is to take the medication with a full glass of water. This is crucial to help prevent esophageal irritation. Option A is correct as alendronate should be taken in the morning on an empty stomach. Option C is incorrect because the client should remain upright for at least 30 minutes after taking the medication, not lie down. Option B is incorrect and a duplicate of Option A.

2. A client comes to the antepartal clinic and tells the nurse that she is 6 weeks pregnant. Which sign is she most likely to report?

• A. Decreased sexual libido
• B. Amenorrhea
• C. Quickening
• D. Nocturia

Correct answer: B

Rationale: Amenorrhea is the absence of menstrual periods and is a common early sign of pregnancy, typically reported by a client who is 6 weeks pregnant. Decreased sexual libido (Choice A) may or may not be experienced in early pregnancy, but it is not as specific as amenorrhea. Quickening (Choice C) refers to fetal movements felt by the mother, which usually occurs around 18-20 weeks of pregnancy, not at 6 weeks. Nocturia (Choice D) is waking up at night to urinate and is not typically associated with early pregnancy.

3. A client with chronic obstructive pulmonary disease (COPD) is using a metered-dose inhaler (MDI). What technique should the nurse emphasize?

• A. The importance of using a spacer
• B. How to synchronize breaths with inhaler activation
• C. Regular cleaning of the inhaler
• D. All of the above

Correct answer: D

Rationale: In managing COPD with a metered-dose inhaler (MDI), the nurse should emphasize all of the techniques mentioned. Using a spacer can help improve drug delivery and reduce the risk of oral thrush. Synchronizing breaths with inhaler activation ensures proper medication delivery to the lungs. Regular cleaning of the inhaler prevents blockages and ensures optimal functioning. Therefore, all these techniques are important for effective COPD management, making 'All of the above' the correct answer. Choices A, B, and C are all crucial components of proper MDI technique in COPD, so they are not individually sufficient without the others.

4. The nurse is with a client when the healthcare provider explains that the biopsy classifies the results as a T1N0M0 tumor. What response should the nurse provide first?

• A. The letters represent tumor size, node involvement, and metastasis in cancer staging.
• B. The letters stand for tumor size, node involvement, and metastasis.
• C. Let me explain the cancer staging to you.
• D. Would you like further clarification on the tumor staging?

Correct answer: B

Rationale: Choice B is the correct answer as it accurately explains that the letters T, N, and M in cancer staging represent tumor size, node involvement, and metastasis, respectively. Understanding this staging system helps the client comprehend the extent and severity of the disease. Choices A, C, and D are incorrect. Choice A has the correct information but is not the most precise response. Choice C is vague and does not directly address the client's need for clarification. Choice D offers further clarification without directly addressing the initial explanation provided by the healthcare provider.

5. The nurse is caring for a client who underwent a total knee replacement yesterday. What activity level should the nurse encourage today?

• A. Bed rest with bathroom privileges only
• B. Frequent, short walks with assistance
• C. Range of motion exercises to the knee every four hours
• D. Leg elevation to reduce swelling

Correct answer: B

Rationale: After a total knee replacement, early ambulation is crucial for promoting circulation and preventing complications like thrombosis. Bed rest should be avoided as it can increase the risk of complications. Range of motion exercises are important but should be performed gradually and not excessively. Leg elevation is beneficial for reducing swelling but should not be the primary activity level encouraged immediately after surgery.

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