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. The wife of a client with Parkinson's disease expresses concern because her husband has lost so much weight. Which teaching is best for the nurse to provide?

• A. Invite friends over regularly to share meal times
• B. Encourage the client to drink clear liquids between meals
• C. Coach the client to make an intentional effort to swallow
• D. Talk to the healthcare provider about prescribing an appetite stimulant

Correct answer: A

Rationale: The best teaching for the nurse to provide is to invite friends over regularly to share meal times. This can help in making meal times more enjoyable for the client with Parkinson's disease, potentially encouraging him to eat more. Encouraging clear liquids between meals (choice B) may not address the underlying issue of weight loss. Coaching the client to make an intentional effort to swallow (choice C) may not be effective if the weight loss is due to other factors related to Parkinson's disease. While prescribing an appetite stimulant (choice D) could be an option, it is usually recommended to explore non-pharmacological interventions first, making choice A the most appropriate initial teaching intervention.

3. During the admission interview, an older client answers some questions inappropriately. The nurse notes that a hearing aid is in one ear. Which intervention is most helpful in assisting the client to hear the nurse’s question?

• A. Move to the client's other side.
• B. Speak louder into the client's ear with the hearing aid.
• C. Ask the client to adjust the hearing aid volume.
• D. Restate questions articulating consonants carefully.

Correct answer: D

Rationale: Restating questions with clear articulation is the most helpful intervention in assisting the client to hear the nurse's question. This approach ensures that the client can better understand the question, especially if there are issues with the hearing aid. Moving to the client's other side or speaking louder into the ear with the hearing aid may not effectively address the problem of clarity in communication. Asking the client to adjust the hearing aid volume assumes that the issue lies solely with the volume, while restating questions with clear articulation can help overcome various hearing difficulties.

4. Which laboratory results should the nurse anticipate to be abnormal in a child with hemophilia?

• A. Prothrombin time
• B. Bleeding time
• C. Platelet count
• D. Partial thromboplastin time

Correct answer: D

Rationale: In a child with hemophilia, the nurse should anticipate an abnormality in the partial thromboplastin time (PTT) due to the deficiency in clotting factors. Prothrombin time, bleeding time, and platelet count are typically normal in hemophilia. Prothrombin time measures the extrinsic pathway of coagulation and is not affected in hemophilia. Bleeding time assesses platelet function, which is normal in hemophilia as the issue lies with clotting proteins, not platelets. Platelet count is also expected to be normal unless there is another underlying condition affecting platelet production or function.

5. The client with osteoporosis is being taught about dietary modifications by the nurse. Which food should the nurse recommend to increase calcium intake?

• A. Broccoli
• B. Chicken breast
• C. White bread
• D. Apple

Correct answer: A

Rationale: Broccoli is the correct answer as it is a good source of calcium, which is essential for clients with osteoporosis. Broccoli is a green leafy vegetable that provides a significant amount of calcium. Chicken breast, white bread, and apple do not contain as much calcium as broccoli and therefore are not the best choices to recommend for increasing calcium intake in clients with osteoporosis.

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