Nursing Elites

1. A male client with diabetes mellitus takes NPH/regular 70/30 insulin before meals and azithromycin PO daily, using medication he brought from home. When the nurse delivers his breakfast tray, the client tells the nurse that he took his insulin but forgot to take his daily dose of azithromycin an hour before breakfast as instructed. What action should the nurse implement?

• A. Provide a PRN dose of an antacid to take with the azithromycin right after breakfast
• B. Offer to obtain a new breakfast tray in an hour so the client can take the azithromycin
• C. Instruct the client to eat his breakfast and take the azithromycin two hours after eating
• D. Tell the client to skip that day's dose and resume taking the azithromycin the next day

Correct answer: C

Rationale: Azithromycin should ideally be taken on an empty stomach; however, if taken after breakfast, it should not affect its efficacy. Instructing the client to eat his breakfast and take the azithromycin two hours after eating allows for proper absorption without compromising its effectiveness. Providing an antacid with azithromycin is not necessary in this case. Offering a new breakfast tray in an hour or skipping the dose is not the best course of action as it may lead to missed doses and potential effectiveness issues.

2. A client is admitted for an exacerbation of heart failure (HF) and is being treated with diuretics for fluid volume excess. In planning nursing care, which interventions should the nurse include? (Select all that apply)

• A. Encourage oral fluid intake of 3,000 ml/day
• B. Observe for evidence of hypokalemia
• C. Teach the client how to restrict dietary sodium
• D. Monitor PTT, PT, and INR lab values

Correct answer: B

Rationale: The correct interventions to include when a client with heart failure is being treated with diuretics for fluid volume excess are to observe for evidence of hypokalemia. Diuretics can lead to potassium loss, resulting in hypokalemia. Monitoring for this electrolyte imbalance is crucial. Encouraging oral fluid intake of 3,000 ml/day may exacerbate fluid volume excess in a client with heart failure. Teaching the client how to restrict dietary sodium is important in managing heart failure, but it is not directly related to the use of diuretics for fluid volume excess. Monitoring PTT, PT, and INR lab values is not typically associated with diuretic therapy for heart failure but rather with anticoagulant therapy.

3. A client presents to the healthcare provider with fatigue, poor appetite, general malaise, and vague joint pain that improves mid-morning. The client has been using over-the-counter ibuprofen for several months. The healthcare provider makes an initial diagnosis of rheumatoid arthritis (RA). Which laboratory test should the nurse report to the healthcare provider?

• A. Sedimentation rate
• B. White blood cell count
• C. Anti–CCP antibodies
• D. Activated Clotting Time

Correct answer: A

Rationale: The correct answer is A: Sedimentation rate. Sedimentation rate, Anti–CCP antibodies, and C-reactive protein are commonly used laboratory tests to indicate inflammation and help diagnose rheumatoid arthritis. An elevated sedimentation rate is a nonspecific indicator of inflammation in the body, which is often seen in RA. White blood cell count is not specific for RA and is not typically significant in the diagnosis. Anti–CCP antibodies are specific to RA and are useful in confirming the diagnosis. Activated Clotting Time is not relevant to the diagnosis of rheumatoid arthritis as it is not specific to this condition.

4. When designing a program to provide primary preventative health care to a community-based healthcare system, which service should the nurse consider for inclusion in the program? Select all that apply.

• A. Breast screening for older women
• B. Rehabilitation services for stroke victims
• C. Blood pressure assessments
• D. Antepartum nutritional counseling

Correct answer: A

Rationale: The correct answer is A: Breast screening for older women. In the context of primary preventative health care, breast screening for older women is crucial for early detection of breast cancer. Choice B, rehabilitation services for stroke victims, focuses on rehabilitative care rather than primary preventative care. Choice C, blood pressure assessments, is important for monitoring health status but not exclusive to primary prevention. Choice D, antepartum nutritional counseling, is more related to prenatal care than primary preventative health care. Therefore, choices B, C, and D do not directly align with the primary preventative health care objective of the grant.

5. The parents of a 6-year-old child recently diagnosed with Duchenne muscular dystrophy tell the nurse that their child wants to continue attending swimming classes. How should the nurse respond?

• A. Encourage the parents to allow the child to continue attending swimming lessons with supervision
• B. Suggest that the child be encouraged to participate in a team sport to promote socialization
• C. Explain that their child is not mature enough to understand the risks associated with swimming
• D. Provide a list of alternative activities that are less likely to cause the child to experience fatigue

Correct answer: A

Rationale: Encouraging the parents to allow the child to continue attending swimming lessons with supervision is the most appropriate response. Swimming can be beneficial for the child, providing both exercise and enjoyment. Supervision can help manage any risks associated with swimming. Choice B is incorrect because the child's preference for swimming should be respected, and swimming can still offer socialization opportunities. Choice C is incorrect as it undermines the child's capability to understand the situation. Choice D is less appropriate as it does not address the child's interest in swimming and may limit beneficial physical activity.

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