Nursing Elites

1. A client who is postpartum requests information about contraception. Which of the following instructions should the nurse include?

• A. The lactation amenorrhea method is effective for the first year postpartum.
• B. You should not use the diaphragm used before your pregnancy.
• C. Apply the transdermal birth control patch on your upper arm.
• D. Avoid using vaginal spermicides while breastfeeding.

Correct answer: D

Rationale: The correct answer is to advise the client to avoid using vaginal spermicides while breastfeeding. This instruction is important as spermicides can potentially affect the milk supply and cause irritation. Choice A is incorrect because the effectiveness of the lactation amenorrhea method diminishes after the first six months postpartum. Choice B is incorrect as using the diaphragm used before pregnancy may not fit properly due to changes in the body postpartum. Choice C is incorrect as the transdermal birth control patch is typically applied to the abdomen, buttocks, or upper torso, not specifically the upper arm.

2. A nurse is caring for a client who has heart failure and a prescription for furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?

• A. Increased shortness of breath.
• B. Decreased peripheral edema.
• C. Increased jugular venous distention.
• D. Increased heart rate.

Correct answer: B

Rationale: The correct answer is B: Decreased peripheral edema. Furosemide is a diuretic that helps in reducing fluid overload in clients with heart failure by increasing urine output. A decrease in peripheral edema indicates that the medication is effectively removing excess fluid from the body. Choices A, C, and D are incorrect because they do not indicate an improvement in the client's condition. Increased shortness of breath, increased jugular venous distention, and increased heart rate are all signs of worsening heart failure and would not be expected findings when furosemide is effective.

3. How should a healthcare provider respond to a patient refusing treatment for religious reasons?

• A. Respect the patient's beliefs
• B. Attempt to persuade the patient
• C. Provide education on treatment benefits
• D. Document the refusal and notify the provider

Correct answer: A

Rationale: Respecting the patient's beliefs is crucial in providing patient-centered care. Attempting to persuade the patient may violate their autonomy and decision-making capacity, leading to a breakdown in trust. Providing education on treatment benefits may be appropriate in other situations but is not the best approach when a patient refuses treatment based on religious reasons. Documenting the refusal and notifying the provider are important steps to ensure proper continuity of care, but the primary response should be to respect the patient's beliefs to maintain a trusting relationship and uphold ethical standards.

4. A nurse is assessing a client who has just received an opioid medication. Which of the following findings should the nurse monitor first?

• A. Constipation.
• B. Drowsiness.
• C. Orthostatic hypotension.
• D. Respiratory depression.

Correct answer: D

Rationale: When a client receives an opioid medication, the nurse should first monitor for respiratory depression as it is a life-threatening adverse effect associated with opioids. This can lead to inadequate ventilation and hypoxia, requiring immediate intervention. Constipation, drowsiness, and orthostatic hypotension are also common side effects of opioids but are not as immediately life-threatening as respiratory depression.

5. A nurse is caring for a client who has severe hypertension and is receiving nitroprusside. What action should the nurse take?

• A. Administer oxygen and assess the client's response.
• B. Monitor blood pressure every 2 hours.
• C. Limit light exposure to the IV infusion.
• D. Attach an inline filter to the IV tubing.

Correct answer: C

Rationale: The correct action for the nurse to take when caring for a client receiving nitroprusside for severe hypertension is to limit light exposure to the IV infusion. Nitroprusside is light-sensitive, and exposure to light can lead to degradation of the medication, reducing its effectiveness. Administering oxygen (Choice A) may be necessary for some clients but is not directly related to the administration of nitroprusside. Monitoring blood pressure every 2 hours (Choice B) is a general nursing intervention for clients with hypertension but does not specifically address the administration of nitroprusside. Attaching an inline filter to the IV tubing (Choice D) is not necessary to address the specific concern of light exposure related to nitroprusside administration.

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