Nursing Elites

1. During a change-of-shift report at a long-term care facility, a nurse discusses an older adult client with shingles with an oncoming nurse. What information should the nurse include in the report?

• A. The location of the client's breakfast.
• B. The schedule for administering routine vital signs.
• C. The specific transmission-based precautions in place.
• D. The type of transmission-based precautions in place.

Correct answer: D

Rationale: The correct answer is to include the type of transmission-based precautions in the report. This information is crucial for infection control when caring for a client with shingles, as it helps prevent the spread of the virus to other clients and healthcare workers. Choices A, B, and C are not directly related to managing a client with shingles. Option A about the location of breakfast is irrelevant to the client's condition. Option B about vital sign measurements, though important, is not the priority when discussing a client with shingles. Option C mentions 'specific times the client had visitors,' which is not as crucial as knowing the specific precautions in place to prevent transmission of the virus.

2. A client is to receive cimetidine (Tagamet) 300 mg q6h IVP. The preparation arrives from the pharmacy diluted in 50 ml of 0.9% NaCl. The LPN plans to administer the IVPB dose over 20 minutes. For how many ml/hr should the infusion pump be set to deliver the secondary infusion?

• A. 150
• B. 50
• C. 100
• D. 75

Correct answer: A

Rationale: Setting the infusion pump to 150 ml/hr ensures the correct administration rate of the IVPB dose over 20 minutes. To calculate the infusion rate, consider that the total volume to be infused is 50 ml over 20 minutes. To convert this to ml/hr, the calculation is (50 ml / 20 minutes) x 60 minutes/hr = 150 ml/hr. Choices B, C, and D are incorrect as they do not reflect the correct calculation for the infusion rate needed to deliver the secondary infusion over the specified time.

3. A client diagnosed with a terminal illness asks the nurse about the nurse’s religious beliefs related to death and dying. An appropriate nursing response is to:

• A. Share personal beliefs
• B. Encourage the client to express their thoughts about death and dying
• C. Redirect the conversation to medical treatment
• D. Inform the client that the nurse’s beliefs are not relevant

Correct answer: B

Rationale: Encouraging the client to express their own thoughts about death and dying is an appropriate nursing response in this situation. It allows the client to explore and express their feelings, fears, and beliefs, facilitating a therapeutic conversation. Sharing personal beliefs (choice A) may not be appropriate as it could impose the nurse's beliefs on the client and hinder open discussion. Redirecting the conversation to medical treatment (choice C) may avoid addressing the client's emotional and spiritual needs. Informing the client that the nurse’s beliefs are not relevant (choice D) dismisses the client's concerns and does not encourage open communication.

4. When teaching a client how to administer medication through a jejunostomy tube, which of the following instructions should the nurse include?

• A. Flush the tube before and after each medication.
• B. Mix medications with enteral feeding.
• C. Push tablets through the tube slowly.
• D. Mix crushed medications before dissolving them in water.

Correct answer: A

Rationale: The correct answer is to flush the tube before and after each medication administration. This helps prevent clogging and ensures the medication is delivered properly. Mixing medications with enteral feeding (choice B) is incorrect as medications should be administered separately. Pushing tablets through the tube (choice C) is not recommended as they should be properly dissolved before administration. Mixing all crushed medications before dissolving them in water (choice D) is incorrect; medications should be dissolved individually to avoid interactions or inconsistencies in dosages.

5. A client has a prescription for a 24-hour urine collection. Which of the following actions should the nurse take?

• A. Discard the first voiding.
• B. Keep the urine in a single container on ice.
• C. Include the last voiding in the collection.
• D. Instruct the client to urinate into the toilet, stop midstream, and finish urinating into the specimen container.

Correct answer: A

Rationale: The correct action for the nurse to take when a client has a prescription for a 24-hour urine collection is to discard the first voiding. This initial voiding is typically not collected to allow for the accurate start of the 24-hour collection period. All subsequent urine voided within the specified time frame is then collected. Including the last voiding in the collection is important to ensure that the full 24-hour period is covered. It is essential to keep the urine cool by storing it in a single container on ice to prevent degradation of components. Instructing the client to stop midstream and finish urinating into the specimen container is not required for a 24-hour urine collection and is an unnecessary step.

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