Nursing Elites

1. A patient is being visited at home by a healthcare professional. The patient has been taking Naproxen for back pain. Which statement made by the patient most indicates that the healthcare professional needs to contact the physician?

• A. I get an upset stomach if I don't take Naproxen with my meals.
• B. My back pain right now is about a 3/10.
• C. I get occasional headaches since taking Naproxen
• D. I have ringing in my ears.

Correct answer: D

Rationale: The correct answer is 'I have ringing in my ears.' Ringing in the ears is a severe adverse effect of Naproxen, indicating potential toxicity. This symptom warrants immediate medical attention. Choices A, B, and C are less concerning and do not directly indicate a severe adverse effect or toxicity related to Naproxen. Upset stomach, mild back pain, and occasional headaches are common side effects that may not require immediate physician contact.

2. A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

• A. Instruct the patient to cough every hour
• B. Monitor the patient for shortness of breath
• C. Verify the position of the balloon every 4 hours
• D. Deflate the gastric balloon if the patient reports nausea

Correct answer: B

Rationale: The correct nursing action for a patient with balloon tamponade for bleeding esophageal varices is to monitor the patient for shortness of breath. The most common complication of balloon tamponade is aspiration pneumonia. Additionally, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Instructing the patient to cough every hour is incorrect as coughing increases the pressure on the varices and raises the risk of bleeding. Verifying the position of the balloon every 4 hours is unnecessary as it is typically done after insertion. Deflating the gastric balloon if the patient reports nausea is incorrect because deflating it may cause the esophageal balloon to occlude the airway, leading to complications. Therefore, monitoring for signs of respiratory distress is crucial in this situation.

3. What action will the nurse plan to take for a 40-year-old patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder?

• A. Decrease the patient's evening fluid intake.
• B. Teach the patient how to use the Cred method.
• C. Suggest the use of adult incontinence briefs for nighttime only.
• D. Assist the patient to the commode every 2 hours during the day.

Correct answer: B

Rationale: For a 40-year-old patient with multiple sclerosis experiencing urinary retention due to a flaccid bladder, teaching the Cred method is the appropriate action. The Cred method involves applying manual pressure over the bladder to aid in bladder emptying. Decreasing fluid intake is not the correct approach as it will not address the underlying issue of bladder emptying and may lead to dehydration and urinary tract infections. Using adult incontinence briefs only addresses the symptom of incontinence without addressing the bladder emptying problem. Assisting the patient to the commode every 2 hours does not actively address the issue of improving bladder emptying as effectively as teaching the Cred method.

4. A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. What information should the nurse provide to the parents?

• A. Nighttime (nocturnal) enuresis does not respond to treatment.
• B. Nighttime (nocturnal) enuresis is caused by a psychiatric problem.
• C. Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem.
• D. Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention.

Correct answer: D

Rationale: Nighttime (nocturnal) enuresis is common in children and is characterized by a child who has never been dry at night for extended periods. Most children eventually outgrow bedwetting without therapeutic intervention. This condition is due to the child being unable to sense a full bladder and not awakening to void, often related to delayed maturation of the central nervous system. It is important for parents to understand that nighttime (nocturnal) enuresis is not caused by a psychiatric problem, does not typically require surgical intervention, and usually resolves on its own over time.

5. A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?

• A. Administer both drugs.
• B. Administer the spironolactone.
• C. Withhold the spironolactone and administer the furosemide.
• D. Withhold both drugs until discussed with the healthcare provider.

Correct answer: B

Rationale: A serum potassium level of 3.2 mEq/L is low (hypokalemia), which can be concerning in a patient with cirrhosis who is already at risk for electrolyte imbalances. Spironolactone is a potassium-sparing diuretic that can help increase the patient's potassium level and correct the hypokalemia. Therefore, the appropriate action for the nurse to take in this scenario is to administer the spironolactone. Withholding the spironolactone could further lower the potassium level. Furosemide, on the other hand, is a loop diuretic that can lead to potassium loss and worsen hypokalemia; hence, it should be withheld until the nurse discusses the situation with the healthcare provider. While the healthcare provider should be informed about the low potassium value, immediate administration of spironolactone is necessary to address the hypokalemia in this patient population.

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