Nursing Elites

1. A client with a recent total knee replacement is scheduled for physical therapy. The client refuses to participate, stating that the pain is too intense. What should the nurse do first?

• A. Administer the prescribed analgesic and encourage participation after it takes effect.
• B. Reschedule the physical therapy session for later in the day.
• C. Explain the importance of physical therapy for recovery.
• D. Notify the physical therapist of the client's refusal.

Correct answer: A

Rationale: Administering pain medication before physical therapy helps manage the pain, making it easier for the client to participate in the necessary exercises to improve recovery and prevent complications such as joint stiffness. Choice B is not the first step as addressing the pain should take precedence. Choice C is important but should come after managing the pain to facilitate participation. Choice D involves another healthcare provider and is not the immediate action needed in this situation.

2. A client is complaining of a tingling sensation in the fingers, nose tip, and earlobes 24 hours after a total thyroidectomy. Which measure should the PN implement first?

• A. Apply sequential compression devices bilaterally
• B. Initiate prescribed L-thyroxine replacement therapy
• C. Obtain prescribed calcium gluconate for tetany
• D. Prepare for emergency tracheotomy at the bedside

Correct answer: C

Rationale: The correct answer is C: Obtain prescribed calcium gluconate for tetany. Tingling sensations post-thyroidectomy may indicate hypocalcemia, a potential complication that requires prompt treatment with calcium gluconate to prevent tetany. Initiating L-thyroxine replacement therapy (choice B) is important but not the first priority in this situation. Applying sequential compression devices (choice A) is not indicated for tingling sensations and does not address the potential complication of hypocalcemia. Preparing for an emergency tracheotomy (choice D) is not warranted based on the client's symptoms of tingling sensations.

3. A female Native American client who is receiving chemotherapy places a native artifact, an Indian medicine wheel, in her hospital room. The HCP removes the medicine wheel and tells the client, 'This type of thing does not belong in the hospital.' Which intervention should the PN implement?

• A. Teach the client about the importance of adhering to the chemotherapy regimen
• B. Act as the client's advocate when addressing the issue with the HCP
• C. Consult with a Native American healer about the appropriate use of a medicine wheel
• D. Inform the HCP about the client's feelings of culture shock

Correct answer: B

Rationale: Acting as the client's advocate is the most appropriate intervention in this situation. Removing a culturally significant artifact without considering the client's beliefs and emotional needs can be distressing. By advocating for the client, the PN can ensure that the client's cultural practices are respected, which is crucial for her emotional and spiritual well-being during treatment. Choice A is incorrect because while chemotherapy adherence is important, it is not the most immediate concern in this scenario. The client's cultural needs and well-being take precedence. Choice C is incorrect because consulting with a Native American healer might not be necessary at this point and could delay addressing the immediate issue of advocating for the client's rights. Choice D is incorrect because simply reporting the client's feelings of culture shock to the HCP does not actively address the situation or advocate for the client's rights and cultural needs.

4. A registered nurse is preparing to hang the first bag of total parenteral nutrition (TPN) solution. The client has a central line, and this is the first bag he will receive. Which of the following is the most essential piece of equipment to obtain prior to hanging the bag?

• A. Blood glucose meter
• B. Noninvasive blood pressure monitor
• C. Electronic infusion pump
• D. Urine test strips

Correct answer: C

Rationale: An electronic infusion pump is essential for administering TPN to ensure accurate delivery and avoid complications such as fluid overload or improper nutrient delivery. The pump helps regulate the flow rate precisely, which is crucial when infusing TPN. Monitoring the client's blood glucose is important but not immediately necessary before hanging the TPN bag. A noninvasive blood pressure monitor is not directly related to administering TPN and is not the most essential equipment needed for this procedure. Urine test strips are not required for administering TPN via a central line and are not essential equipment for this specific task.

5. Which of the following is a priority for the nurse to include in the teaching of a client who was recently prescribed alprazolam (Xanax) as an oral medication?

• A. Monitor heart rate before taking the medication
• B. Monitor temperature daily
• C. Avoid unprotected exposure to sunlight
• D. Avoid alcohol

Correct answer: D

Rationale: The correct answer is D: 'Avoid alcohol.' Alprazolam (Xanax) can have central nervous system depressant effects, which are exacerbated by alcohol. It is crucial to avoid alcohol while taking this medication to prevent severe sedation and respiratory depression. Monitoring heart rate (choice A) is not directly related to alprazolam administration. Monitoring temperature daily (choice B) is not a priority teaching point for a client prescribed alprazolam. Avoiding unprotected exposure to sunlight (choice C) is not specifically linked to the use of alprazolam.

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