Nursing Elites

1. A client with rheumatoid arthritis is prescribed methotrexate. What information should the LPN include when teaching the client about this medication?

• A. Avoid exposure to sunlight.
• B. Take the medication with food.
• C. Increase fluid intake while on this medication.
• D. Report any signs of infection to the healthcare provider immediately.

Correct answer: D

Rationale: The correct answer is D: 'Report any signs of infection to the healthcare provider immediately.' Methotrexate is an immunosuppressant medication commonly used to treat rheumatoid arthritis. It can lower the immune system's ability to fight infections, making it crucial for clients to promptly report any signs of infection to prevent serious complications. Choices A, B, and C are incorrect because avoiding sunlight, taking the medication with food, and increasing fluid intake are not specific to methotrexate therapy and are not primary concerns associated with this medication.

2. A staff nurse is teaching a newly hired nurse about alternatives to the use of restraints on clients who are confused. Which of the following instructions should the staff nurse include?

• A. Remove clocks from the client’s room
• B. Use full-length side rails on the client’s bed
• C. Check on the client frequently while they are in the restroom
• D. Encourage physical activity throughout the day to expend energy

Correct answer: D

Rationale: Encouraging physical activity throughout the day is an effective way to manage confusion in clients and reduce the need for restraints. Physical activity helps in expending energy, promoting circulation, and improving overall well-being. Removing clocks from the client’s room (choice A) may not directly address the issue of confusion or reduce the need for restraints. Using full-length side rails on the client’s bed (choice B) can actually increase the risk of entrapment and should be avoided. Checking on the client frequently while they are in the restroom (choice C) is important for monitoring safety but may not directly address the underlying issue of confusion and the need for restraints.

3. A healthcare professional is caring for a client who has a prescription for a stool specimen to be sent to the laboratory to be tested for ova and parasites. Which of the following instructions regarding specimen collection should the healthcare professional provide to the assistive personnel?

• A. Collect at least 2 inches of formed stool.
• B. Wear sterile gloves while obtaining the specimen.
• C. Use a culturette for specimen collection.
• D. Record the date and time the stool was collected.

Correct answer: A

Rationale: To ensure accurate testing, a minimum amount of stool is required for specimen collection, typically at least 2 inches of formed stool. This amount provides an adequate sample for testing. Wearing sterile gloves is important for infection control but is not specifically required for stool specimen collection. Using a culturette is not typically necessary for collecting stool specimens. Recording the date and time the stool was collected is essential to ensure timely processing but does not directly impact the collection of the specimen itself.

4. While instructing a male client's wife in the performance of passive range-of-motion exercises to his contracted shoulder, the nurse observes that she is holding his arm above and below the elbow. What nursing action should the LPN/LVN implement?

• A. Acknowledge that she is supporting the arm correctly.
• B. Encourage her to keep the joint covered to maintain warmth.
• C. Reinforce the need to grip directly under the joint for better support.
• D. Instruct her to grip directly over the joint for better motion.

Correct answer: A

Rationale: Acknowledging that the client's wife is supporting the arm correctly is the appropriate nursing action in this scenario. By doing so, the nurse reinforces correct technique and promotes confidence. Choice B is incorrect as the issue is not about maintaining warmth. Choice C is incorrect as gripping directly under the joint is not necessary in this case. Choice D is incorrect as instructing to grip directly over the joint may not provide the best support for passive range-of-motion exercises.

5. A client who is postoperative and has paralytic ileus is being cared for by a nurse. Which of the following abdominal assessments should the nurse expect?

• A. Absent bowel sounds with distention
• B. Hyperactive bowel sounds
• C. Normal bowel sounds
• D. High-pitched bowel sounds

Correct answer: A

Rationale: In a client with paralytic ileus, absent bowel sounds with distention are expected due to decreased or absent bowel motility. This is a key characteristic of paralytic ileus, where the bowel is unable to contract and move contents along the digestive tract. Hyperactive bowel sounds (choice B) are more indicative of increased peristalsis, which is not typically seen in paralytic ileus. Normal bowel sounds (choice C) may not be present in a client with paralytic ileus. High-pitched bowel sounds (choice D) are not typically associated with paralytic ileus. Therefore, the correct assessment finding in this scenario is absent bowel sounds with distention.

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