Nursing Elites

1. A client with cancer develops xerostomia. The nurse can help alleviate the discomfort associated with xerostomia by:

• A. Offering hard candy
• B. Administering analgesic medications
• C. Splinting swollen joints
• D. Providing saliva substitute

Correct answer: D

Rationale: Xerostomia is dry mouth, a common side effect in cancer patients. Providing a saliva substitute helps alleviate the discomfort associated with dry mouth by moistening the oral mucosa. Offering hard candy, as mentioned in choice A, can worsen xerostomia by increasing sugar content and potentially causing irritation. Administering analgesic medications, as in choice B, is not directly related to treating dry mouth. Splinting swollen joints, as in choice C, is irrelevant to xerostomia, which primarily affects the oral cavity.

2. Fat emulsions are frequently administered as a part of total parenteral nutrition. Which statement is true regarding fat emulsions?

• A. They have a high energy-to-fluid-volume ratio.
• B. Even though hypertonic, they are well tolerated.
• C. They are a basic solution due to the addition of sodium hydroxide (NaOH).
• D. The pH is alkaline, making them compatible with most medications.

Correct answer: A

Rationale: The correct statement is that fat emulsions have a high energy-to-fluid-volume ratio. Fat emulsions are formulated in 10%, 20%, and 30% solutions and supply 1.1, 2, and 3 kilocalories, respectively, for each milliliter. In comparison, a milliliter of 5% dextrose only supplies 0.17 kilocalories. Choices B, C, and D are incorrect. Choice B is false because fat emulsions are essentially pH neutral and isotonic, not hypertonic. Choice C is incorrect because fat emulsions are not basic solutions; they are essentially pH neutral. Choice D is incorrect as fat emulsions are not alkaline; they are pH neutral, making them compatible with most medications.

3. In which age group does the highest incidence of child abuse occur?

• A. Birth-3 years old
• B. 4-6 years old
• C. 6-10 years old
• D. More than 10 years old

Correct answer: A

Rationale: The correct answer is 'Birth-3 years old.' Children between birth and 3 years of age have the highest rates of victimization (at 16 per 1,000 children). This age group is most vulnerable due to their dependency and inability to report or protect themselves effectively. Child abuse can occur at any age, but statistics show that infants and toddlers are at the highest risk due to their developmental stage and reliance on caregivers. Choices B, C, and D are incorrect because while child abuse can happen at any age, the prevalence is highest among children in the 0-3 age group.

4. Which of the following coping mechanisms protects an individual from anxiety?

• A. denial and fantasy
• B. rationalization and suppression
• C. regression and displacement
• D. reaction formation and projection

Correct answer: A

Rationale: The correct answer is 'denial and fantasy.' Denial involves blocking external events from awareness to avoid anxiety, while fantasy is escaping to a more comfortable, less threatening place. These mechanisms can protect individuals from anxiety by providing temporary relief or distraction. Choices B, C, and D are incorrect. Rationalization and suppression do not directly protect individuals from anxiety. Regression and displacement involve reverting to earlier developmental stages or redirecting emotions to a substitute target, which do not directly shield individuals from anxiety. Reaction formation and projection entail behaving in the opposite way to one's impulses or attributing one's feelings to others respectively, which do not directly protect individuals from anxiety.

5. Narrow therapeutic index medications:

• A. are drug formulations with limited pharmacokinetic variability.
• B. have limited value and require no monitoring of blood levels.
• C. have less than a twofold difference in minimum toxic levels and minimum effective concentration in the blood
• D. have limited potency and side effects.

Correct answer: C

Rationale: The therapeutic index is the ratio between the median lethal dose and median effective dose of a drug, indicating the safety margin. Narrow therapeutic index medications have a small difference between minimum toxic levels and minimum effective concentration in the blood, making them high-risk drugs that require close monitoring to avoid toxicity. Choice A is incorrect because pharmacokinetics refer to drug absorption, distribution, metabolism, and elimination, not the therapeutic index. Choice B is incorrect because narrow therapeutic index drugs necessitate monitoring due to their narrow margin of safety. Choice D is incorrect because narrow therapeutic index drugs do not necessarily have limited potency but are characterized by a small window between efficacy and toxicity.

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