Nursing Elites

1. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should the nurse include in the teaching plan?

• A. Avoid taking folic acid supplements
• B. Report any signs of infection immediately
• C. Limit fluid intake to prevent edema
• D. Increase intake of high-calcium foods

Correct answer: B

Rationale: The correct instruction that the nurse should include in the teaching plan for a client prescribed methotrexate is to report any signs of infection immediately. Methotrexate can suppress the immune system, making the individual more susceptible to infections. Reporting signs of infection promptly allows for timely intervention. Choices A, C, and D are incorrect. Avoiding folic acid supplements is not recommended because methotrexate can lead to folate deficiency, so supplementation may be necessary. There is no direct correlation between fluid intake limitation and methotrexate use. Increasing high-calcium foods is not specifically related to methotrexate therapy for rheumatoid arthritis.

2. A client is receiving a secondary infusion of erythromycin 1 gram in 100 mL dextrose 5% in water (D5W) to be infused in 45 minutes. How many mL/hour should the nurse program the infusion pump?

• A. 100 mL/hour.
• B. 125 mL/hour.
• C. 133 mL/hour.
• D. 150 mL/hour.

Correct answer: C

Rationale: To infuse 100 mL in 45 minutes, the infusion rate should be set to 133 mL/hour (100 mL / 0.75 hours). This calculation is obtained by dividing the total volume to be infused by the total time for infusion (100 mL / 0.75 hours = 133 mL/hour). Therefore, choice C is the correct answer. Choices A, B, and D are incorrect because they do not accurately calculate the infusion rate required to deliver the medication within the specified time frame.

3. The nurse is caring for a client with a suspected stroke. Which assessment finding is most indicative of a stroke?

• A. Chest pain
• B. Sudden confusion and difficulty speaking
• C. Gradual onset of weakness in the legs
• D. Nausea and vomiting

Correct answer: B

Rationale: The correct answer is B: Sudden confusion and difficulty speaking. These are classic signs of a stroke, indicating a neurological deficit that requires urgent medical attention. Choices A, C, and D are less indicative of a stroke. Chest pain is more commonly associated with cardiac issues, gradual onset of weakness in the legs could be related to other conditions like peripheral neuropathy, and nausea/vomiting may suggest gastrointestinal problems rather than a stroke.

4. What is the major criterion for diagnosing cognitive impairment in a child?

• A. An IQ of 75 or less
• B. Subaverage functioning
• C. An IQ of 70 or less
• D. Onset before 18

Correct answer: C

Rationale: The correct criterion for diagnosing cognitive impairment in a child is having an IQ of 70 or less. This range is typically used to define cognitive impairment in children. Choice A ('An IQ of 75 or less') is incorrect as the threshold is generally set at 70 or below. Choice B ('Subaverage functioning') is vague and does not specifically address the IQ criterion. Choice D ('Onset before 18') is unrelated to the primary criterion of IQ level used in diagnosing cognitive impairment in children.

5. A 55-year-old client with symptoms of osteoarthritis asks which form of exercise would be most beneficial. What is the best response by the nurse?

• A. Walking.
• B. Running.
• C. Swimming.
• D. Weight lifting.

Correct answer: C

Rationale: The correct answer is C: 'Swimming.' Swimming is a low-impact exercise that helps maintain joint mobility and reduce pain in clients with osteoarthritis. Unlike running or weight lifting, swimming is gentle on the joints, making it an ideal choice for individuals with osteoarthritis. Walking can be beneficial too, but swimming is often preferred due to its low-impact nature. Running and weight lifting may exacerbate joint pain and should be avoided by individuals with osteoarthritis.

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