Nursing Elites

1. A female client taking a liquid iron preparation expresses concern that her tooth color has darkened since starting the medication. What action should the PN implement?

• A. Teach the client to use a straw when taking the medication to reduce further tooth staining
• B. Advise the client to withhold further doses until consulting with the healthcare provider
• C. Reassure the client that this change indicates the medication is having the desired effect
• D. Determine if the client is also experiencing mouth or gum pain and difficulty swallowing

Correct answer: A

Rationale: The correct action for the PN to implement is to teach the client to use a straw when taking the medication to reduce further tooth staining. Using a straw minimizes contact between the iron preparation and the teeth, helping prevent additional staining. Choice B is incorrect because withholding doses without consulting the healthcare provider could be detrimental to the client's health. Choice C is incorrect because darkening of tooth color is not an expected effect of liquid iron preparation and should not be reassured as a desired effect. Choice D is incorrect as it does not directly address the client's concern about tooth staining.

2. In a group therapy setting, one member is very demanding, repeatedly interrupting others and taking most of the group time. The nurse's best response would be:

• A. Will you briefly summarize your point because others need time as well?
• B. Your behavior is obnoxious and drains the group.
• C. I am so frustrated with your behavior.
• D. To ignore the behavior and allow him to vent

Correct answer: A

Rationale: In a group therapy setting, where each member should have the opportunity to participate, it is essential for the nurse to manage disruptive behavior assertively yet respectfully. Choice A is the best response as it addresses the issue of one member dominating the group time by asking them to summarize their point briefly, allowing others to contribute. Choice B is confrontational and may alienate the individual, hindering the therapeutic process. Choice C expresses personal frustration, which is not constructive in managing the situation. Choice D of ignoring the behavior is not effective as it allows the disruptive behavior to continue, impacting the group dynamics negatively.

3. Which of the following is a primary intervention for a patient experiencing hypoglycemia?

• A. Administering insulin
• B. Providing a complex carbohydrate meal
• C. Giving 15 grams of a fast-acting carbohydrate, like glucose tablets
• D. Encouraging the patient to exercise

Correct answer: C

Rationale: Giving 15 grams of a fast-acting carbohydrate, such as glucose tablets, is the primary intervention for hypoglycemia. This rapid-acting carbohydrate helps quickly raise blood sugar levels, providing immediate relief to the patient. Administering insulin (Choice A) would further lower blood sugar levels, exacerbating the hypoglycemia. Providing a complex carbohydrate meal (Choice B) would not act quickly enough to address the immediate low blood sugar issue. Encouraging the patient to exercise (Choice D) is inappropriate during hypoglycemia as it can further deplete glucose levels.

4. The nurse is assisting the recreational director of a long-term care facility in planning outdoor activities for the wheelchair-bound older residents who are mentally alert. Which activity meets the physical and social needs of these residents?

• A. An open-air concert
• B. A tea party in the courtyard
• C. A team ring-toss competition
• D. A picnic in the park

Correct answer: B

Rationale: A tea party in the courtyard provides a social and physical activity suitable for wheelchair-bound older residents who are mentally alert. It offers an opportunity for social interaction, enjoyment of the outdoors, and participation in a physical activity without the need for extensive mobility. An open-air concert may not provide the same level of social interaction or physical engagement as a tea party. A team ring-toss competition may be physically challenging for wheelchair-bound residents. A picnic in the park could present challenges related to accessibility and might not foster the same level of social interaction as a tea party in a more contained courtyard setting.

5. Which assessment finding would most likely indicate a complication of enteral tube feeding?

• A. Abdominal distension
• B. Weight gain
• C. Decreased bowel sounds
• D. Diarrhea

Correct answer: A

Rationale: Abdominal distension in a patient receiving enteral tube feeding may indicate a complication such as intolerance to feeding, delayed gastric emptying, or obstruction. Abdominal distension is a common sign of gastrointestinal issues related to enteral tube feeding. Weight gain is typically an expected outcome if the patient is receiving adequate nutrition. Decreased bowel sounds may indicate decreased motility but are not specific to enteral tube feeding complications. Diarrhea can occur due to various reasons, including infections, medications, or dietary changes, but it is not the most likely indication of a complication in enteral tube feeding.

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