Nursing Elites

1. A client with a history of chronic back pain is prescribed oxycodone for pain management. What is the most important instruction the nurse should provide?

• A. Take the medication with food to reduce stomach upset
• B. Avoid operating heavy machinery while taking this medication
• C. Increase physical activity to enhance pain relief
• D. Report any signs of respiratory depression immediately

Correct answer: D

Rationale: The correct answer is D: 'Report any signs of respiratory depression immediately.' Respiratory depression is a severe side effect of opioids like oxycodone and can be life-threatening. It is crucial for the nurse to instruct the client to report any signs such as slow or shallow breathing, difficulty breathing, or confusion. Choice A is incorrect as taking oxycodone with or without food does not significantly affect its efficacy. Choice B is incorrect because avoiding driving is important due to the potential impairment caused by oxycodone, but reporting respiratory depression is more critical. Choice C is incorrect as increasing physical activity may not always be suitable for individuals with chronic back pain and is not directly related to preventing respiratory depression.

2. A client admitted to the hospital with advanced liver failure related to chronic alcoholism is exhibiting ascites and edema. Which pathophysiological mechanisms should the nurse identify as responsible for the third spacing symptoms? (Select all that apply.)

• A. Portal hypertension.
• B. Sodium and water retention.
• C. Decreased serum albumin.
• D. All of the above

Correct answer: D

Rationale: In advanced liver failure related to chronic alcoholism, ascites and edema occur due to multiple pathophysiological mechanisms. Portal hypertension contributes to the development of ascites by increasing pressure in the portal venous system. Sodium and water retention exacerbate fluid accumulation in the third space. Decreased serum albumin levels lead to reduced oncotic pressure, contributing to the movement of fluid into the interstitial spaces. Abnormal protein metabolism further disrupts fluid balance. Therefore, all of the options (A, B, and C) are correct in this scenario, making choice D the correct answer. Choices A, B, and C alone do not fully explain the comprehensive pathophysiological mechanisms involved in the development of ascites and edema in this clinical context.

3. A new father asks the nurse the reason for placing an ophthalmic ointment in his newborn's eyes. What information should the nurse provide?

• A. Possible exposure to an environmental staphylococcus infection can infect the newborn's eyes and cause visual deficits
• B. The newborn is at risk for blindness from a corneal syphilitic infection acquired from a mother's infected vagina
• C. Treatment prevents tear duct obstruction with harmful exudate from a vaginal birth that can lead to dry eyes in the newborn
• D. State law mandates all newborns receive prophylactic treatment to prevent gonorrheal or chlamydial ophthalmic infection

Correct answer: D

Rationale: The correct answer is D because informing about state law emphasizes the legal requirement and public health rationale behind prophylactic eye treatment to prevent serious infections like gonorrheal or chlamydial ophthalmic infection. Choices A, B, and C are incorrect. Choice A focuses on staphylococcus infection, which is not the primary concern addressed by the prophylactic ointment. Choice B mentions a specific infection acquired from the mother's infected vagina, which is not the main reason for the ophthalmic ointment. Choice C discusses tear duct obstruction and dry eyes, which are not the primary concerns addressed by the prophylactic ointment.

4. During a health screening, a client's blood pressure reads 160/100 mm Hg. What should the nurse recommend?

• A. Schedule a follow-up appointment
• B. Start making immediate dietary changes
• C. Begin an exercise program
• D. All of the above

Correct answer: A

Rationale: A follow-up with a healthcare provider is necessary to assess and manage the newly identified hypertension. While dietary changes and exercise are important for managing high blood pressure, immediate lifestyle modifications without further evaluation by a healthcare provider may not be safe or effective. Option A is the most appropriate initial step to ensure proper assessment and management of the client's blood pressure. Therefore, choices B and C are incorrect in this scenario. Option D is also incorrect because not all options should be implemented without proper medical guidance.

5. A client with a diagnosis of bipolar disorder is prescribed lithium. Which electrolyte imbalance should the nurse monitor for?

• A. Hyponatremia
• B. Hypokalemia
• C. Hypercalcemia
• D. Hypernatremia

Correct answer: A

Rationale: The correct answer is A: Hyponatremia. Lithium can affect sodium levels in the body, potentially leading to hyponatremia, which is a condition characterized by low sodium levels. This imbalance requires close monitoring as it can lead to symptoms such as confusion, weakness, and even seizures. Choices B, C, and D are incorrect because lithium is not primarily associated with causing hypokalemia, hypercalcemia, or hypernatremia. While these imbalances can occur in certain conditions or with other medications, the main electrolyte imbalance to monitor when a client is prescribed lithium is hyponatremia.

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