Nursing Elites

1. A nurse is caring for a client who has end-stage osteoporosis and is reporting severe pain. The client’s respiratory rate is 14 per minute. Which of the following medications should the nurse prioritize administering?

• A. Promethazine
• B. Hydromorphone
• C. Ketorolac
• D. Amitriptyline

Correct answer: B

Rationale: Hydromorphone, an opioid, is the most appropriate option for managing severe pain in this context. Opioids provide fast-acting relief for acute pain associated with advanced osteoporosis. Promethazine (Choice A) is an antihistamine and not indicated for pain relief. Ketorolac (Choice C) is a nonsteroidal anti-inflammatory drug (NSAID) that may increase the risk of bleeding and is not recommended for severe pain management. Amitriptyline (Choice D) is a tricyclic antidepressant that is not the first-line treatment for severe acute pain.

2. A newly licensed nurse tells a charge nurse he is unsure about accepting telephone medication prescriptions. Which of the following providers should the charge nurse identify as having the legal ability to give telephone medication prescriptions?

• A. Nurse midwives
• B. Physical therapists
• C. Pharmacists
• D. Physician assistants

Correct answer: D

Rationale: Physician assistants are healthcare providers who are licensed to prescribe medications. They have the legal ability to give telephone orders for medications. Nurse midwives primarily focus on providing prenatal care and assisting during labor and delivery. Physical therapists specialize in rehabilitation services. Pharmacists dispense medications and provide medication counseling. Therefore, among the options provided, physician assistants are the correct choice for giving telephone medication prescriptions.

3. A nurse is performing a newborn assessment and notes a soft, swollen area on the newborn's scalp that does not cross the suture line. Which of the following should the nurse document?

• A. Cephalohematoma
• B. Caput succedaneum
• C. Subdural hematoma
• D. Molding

Correct answer: A

Rationale: The correct answer is A, cephalohematoma. A cephalohematoma is a collection of blood between the periosteum and the skull that does not cross the suture line. It is caused by trauma during birth and typically resolves on its own. Choice B, caput succedaneum, is characterized by diffuse edema over a newborn's scalp that crosses suture lines. Choice C, subdural hematoma, is a more serious condition involving bleeding between the dura mater and the brain. Choice D, molding, refers to the shaping of the fetal head during passage through the birth canal. Therefore, the nurse should document cephalohematoma in this scenario as it aligns with the description of a soft, swollen area on the newborn's scalp that does not cross the suture line.

4. A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take first?

• A. Encourage the client to eat the toast on the breakfast tray
• B. Administer an antiemetic
• C. Inform the client's provider
• D. Check the client's apical pulse

Correct answer: D

Rationale: The correct answer is to check the client's apical pulse first. Nausea can be a sign of digoxin toxicity, and assessing the client's heart rate is crucial in this situation. Administering an antiemetic or encouraging the client to eat should come after ensuring the client's safety. While informing the provider is important, the immediate concern is to assess for potential digoxin toxicity by checking the client's apical pulse.

5. A nurse is planning a staff education session regarding biological weapons of mass destruction. What should the nurse include in the session?

• A. Rabies, cholera, meningitis
• B. Smallpox, anthrax, botulism
• C. Ebola, hepatitis B, tetanus
• D. Tuberculosis, influenza, measles

Correct answer: B

Rationale: The correct answer is B: Smallpox, anthrax, botulism. These are known biological weapons that can be used in mass casualty situations. Rabies, cholera, and meningitis (Choice A) are not typically used as biological weapons. Ebola, hepatitis B, and tetanus (Choice C) are serious diseases but are not commonly associated with biological warfare. Tuberculosis, influenza, and measles (Choice D) are infectious diseases but are not typically used as biological weapons of mass destruction.

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