Nursing Elites

1. A patient is receiving radiation therapy. Which of the following skin care instructions should the nurse provide?

• A. Apply a heating pad to the radiation site.
• B. Use scented lotions to moisturize the skin.
• C. Keep the radiation site covered with a bandage.
• D. Wear loose clothing over the radiation site.

Correct answer: D

Rationale: Correct Answer: The nurse should instruct the patient to wear loose clothing over the radiation site. This helps prevent skin irritation and promotes healing by reducing friction and irritation on the treated area.\nChoice A is incorrect because applying a heating pad can further irritate the skin that is already sensitive due to radiation therapy.\nChoice B is incorrect because scented lotions may contain ingredients that could further irritate the skin.\nChoice C is incorrect because covering the radiation site with a bandage can trap moisture and lead to skin breakdown, increasing the risk of infection.

2. A client with heart failure is receiving digoxin. Which of the following findings should the nurse report to the provider?

• A. Heart rate of 78/min.
• B. Vision changes.
• C. Respiratory rate of 16/min.
• D. Blood pressure of 120/80 mm Hg.

Correct answer: B

Rationale: The correct answer is B: Vision changes. Vision changes are a classic sign of digoxin toxicity and should be reported immediately to the provider for further evaluation and management. A heart rate of 78/min, a respiratory rate of 16/min, and a blood pressure of 120/80 mm Hg are within normal ranges and are not typically associated with digoxin toxicity. Therefore, they would not be the priority findings to report in this situation.

3. A nurse is providing teaching about immunizations to a client who is pregnant. The nurse should inform the client that she can receive which of the following immunizations during pregnancy?

• A. Varicella vaccine.
• B. Inactivated polio vaccine.
• C. Tetanus diphtheria and acellular pertussis vaccine.
• D. Inactivated influenza vaccine.

Correct answer: C

Rationale: The correct answer is C: Tetanus diphtheria and acellular pertussis (Tdap) vaccine. The Tdap vaccine can be safely administered during pregnancy to protect both the mother and the newborn against whooping cough. Choices A, B, and D are incorrect because the Varicella vaccine, Inactivated polio vaccine, and Inactivated influenza vaccine are generally not recommended during pregnancy due to safety concerns.

4. A nurse is providing discharge teaching to a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

• A. Avoid eating foods that are high in fat.
• B. Monitor for black, tarry stools while taking this medication.
• C. Avoid taking this medication with grapefruit juice.
• D. Take this medication on an empty stomach.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to monitor for black, tarry stools while taking clopidogrel. This is important because it helps detect gastrointestinal bleeding, a potential side effect of the medication. Choice A is incorrect as there is no specific requirement to avoid foods high in fat while taking clopidogrel. Choice C is incorrect as grapefruit juice interaction is not a concern with clopidogrel. Choice D is incorrect as clopidogrel can be taken with or without food.

5. A client who is at 10 weeks of gestation is being taught about nutrition during pregnancy. Which statement by the client indicates an understanding of the teaching?

• A. I should consume 1,200 calories per day.
• B. I should increase my daily intake of folic acid.
• C. I should drink 2 liters of water each day.
• D. I should limit my intake of iron-rich foods.

Correct answer: B

Rationale: The correct answer is B. Increasing folic acid intake is crucial during pregnancy to prevent neural tube defects. Option A is incorrect because calorie requirements during pregnancy vary and are generally higher than 1,200 calories per day. Option C is not specific to pregnancy nutrition teaching, although hydration is important. Option D is incorrect as iron-rich foods are typically recommended during pregnancy to prevent anemia.

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