Nursing Elites

1. A highly successful individual presents to the community mental health center complaining of sleeplessness and anxiety over their financial status. What action should the nurse take to assist this client in diminishing their anxiety?

• A. Encourage them to initiate daily rituals.
• B. Reinforce the reality of their financial situation.
• C. Direct them to drink a glass of red wine at bedtime.
• D. Teach them to limit sugar and caffeine intake.

Correct answer: D

Rationale: Teaching the individual to limit sugar and caffeine intake is an appropriate intervention to reduce anxiety and improve sleep quality. Sugar and caffeine can exacerbate anxiety symptoms and disrupt sleep patterns. By reducing their intake, the individual may experience a decrease in anxiety levels and better sleep. Encouraging daily rituals, reinforcing financial realities, or suggesting alcohol consumption before bed are not evidence-based strategies for managing anxiety and sleeplessness.

2. What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?

• A. Acute hepatitis
• B. Acute cholecystitis
• C. Acute cholangitis
• D. Pancreatic cancer

Correct answer: C

Rationale: The combination of right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels is classic for acute cholangitis, which is an infection of the bile ducts. Acute hepatitis typically presents with other liver function abnormalities, while acute cholecystitis is characterized by gallbladder inflammation. Pancreatic cancer would not typically present with these specific symptoms and lab findings.

3. A client with a history of asthma is prescribed salmeterol (Serevent). Which instruction should the nurse provide?

• A. Use this medication for acute asthma attacks.
• B. Use this medication before using your albuterol inhaler.
• C. Use this medication twice daily for long-term control.
• D. Use this medication as needed for wheezing.

Correct answer: C

Rationale: The correct instruction for a client prescribed salmeterol (Serevent) is to use it twice daily for long-term control. Salmeterol is a long-acting bronchodilator that is not intended for acute asthma attacks or as-needed use for wheezing. Choice A is incorrect because salmeterol is not used for acute asthma attacks. Choice B is incorrect as salmeterol is not meant to replace the albuterol inhaler but rather used for long-term control. Choice D is incorrect because salmeterol should not be used as needed; it is a maintenance medication for asthma.

4. A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?

• A. Apply the patch to a different site each time.
• B. Change the patch every 72 hours.
• C. Avoid using additional heating pads over the patch.
• D. Remove the patch before showering.

Correct answer: B

Rationale: The most important instruction for the nurse to provide to a patient prescribed a fentanyl patch is to change the patch every 72 hours. This ensures consistent pain control and prevents complications. It is crucial to rotate the application sites to prevent skin irritation or reactions. Using additional heating pads over the patch should be avoided as it can increase the absorption of the medication, leading to overdose or adverse effects. Removing the patch before showering is not necessary as long as the patch is securely in place.

5. A client is being treated with an antidepressant for major depressive disorder. Which statement by the client indicates a need for further teaching?

• A. I know it may take several weeks before I start feeling better.
• B. I should avoid drinking alcohol while taking this medication.
• C. I will stop taking the medication as soon as I feel better.
• D. I should take the medication at the same time every day.

Correct answer: C

Rationale: Choice C indicates a need for further teaching because stopping antidepressants abruptly can lead to withdrawal symptoms. It is essential for the client to follow the healthcare provider's instructions and complete the full course of medication even if they start feeling better to prevent potential relapse or withdrawal effects.

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