Nursing Elites

1. A client is receiving meperidine (Demerol) for pain management. Which assessment finding requires immediate action?

• A. Constipation
• B. Drowsiness
• C. Respiratory rate of 10 breaths per minute
• D. Nausea

Correct answer: C

Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a severe side effect of meperidine (Demerol) that necessitates immediate intervention to prevent further complications. Constipation, drowsiness, and nausea are common but less urgent side effects that do not pose an immediate life-threatening risk. Respiratory depression can lead to respiratory arrest and must be addressed promptly to ensure the client's safety and well-being.

2. The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?

• A. Intestinal obstruction
• B. Peptic ulcer with melena
• C. Diverticulitis with perforation
• D. Vomiting following cancer chemotherapy

Correct answer: D

Rationale: Metoclopramide, also known as Reglan, is commonly used to manage vomiting following cancer chemotherapy. It acts as a gastrointestinal stimulant and antiemetic, aiding in relieving nausea and vomiting associated with chemotherapy. Metoclopramide should be avoided in conditions like intestinal obstruction, peptic ulcer with melena, and diverticulitis with perforation due to its prokinetic properties that can worsen these conditions. Therefore, the correct answer is D: Vomiting following cancer chemotherapy.

3. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:

• A. Immediately before swimming
• B. 15 minutes before exposure to the sun
• C. Immediately before exposure to the sun
• D. At least 30 minutes before exposure to the sun

Correct answer: D

Rationale: Chemical sunscreens are most effective when applied at least 30 minutes before exposure to the sun to allow them to penetrate the skin and provide optimal protection. Applying sunscreen immediately before swimming (Choice A) or immediately before exposure to the sun (Choice C) may not provide sufficient time for the sunscreen to be absorbed and offer proper protection. Applying sunscreen 15 minutes before sun exposure (Choice B) is also not ideal as it may not allow enough time for the sunscreen to work effectively. Therefore, the correct answer is to apply chemical sunscreen at least 30 minutes before exposure to the sun to ensure it can be absorbed and offer the intended protection. It is important to reapply sunscreen after swimming or sweating to maintain its effectiveness.

4. The healthcare provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatment?

• A. The medication is an antibacterial.
• B. The medication will help heal the burn.
• C. The medication will permanently stain my skin.
• D. The medication should be applied directly to the wound.

Correct answer: C

Rationale: The correct answer is C. Silver sulfadiazine is an antibacterial used to treat burns, helping in the healing process. It does not permanently stain the skin. Therefore, the statement indicating a lack of understanding is that the medication will permanently stain the skin.

5. A client has a prescription for albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs) by metered-dose inhaler. The medications are to be administered by the nurse by giving the:

• A. Albuterol first and then the beclomethasone dipropionate
• B. Beclomethasone dipropionate first and then the albuterol
• C. Alternating a single puff of each, beginning with the albuterol
• D. Alternating a single puff of each, beginning with the beclomethasone dipropionate

Correct answer: A

Rationale: Albuterol, as a bronchodilator, should be administered first to help open up the airways, followed by beclomethasone dipropionate to reduce inflammation in the airways. This sequence ensures optimal therapeutic effects of the medications.

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