Nursing Elites

1. When orally administering alendronate (Fosamax), a bisphosphonate drug, to a largely bed-bound patient being treated for osteoporosis, what is the most important nursing consideration?

• A. Sit the head of the bed up for 30 minutes after administration
• B. Give the patient a small amount of water to drink
• C. Feed the patient soon, at most 10 minutes after administration
• D. Assess the patient for back pain or abdominal pain

Correct answer: A

Rationale: The correct nursing consideration when administering bisphosphonates like alendronate is to sit the head of the bed up for 30 minutes after administration. Bisphosphonates are known to cause esophageal irritation, which can lead to esophagitis. By sitting upright, the patient reduces the time the medication spends in the esophagus, decreasing the risk of irritation and potential adverse effects. Giving the patient water to drink or feeding them immediately after administration can increase the risk of esophageal irritation. Assessing the patient for back pain or abdominal pain is important but not the most critical consideration during drug administration.

2. Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select the one that doesn't apply:

• A. It results when oxygen demand is greater than oxygen supply.
• B. It is characterized by pain that often occurs during rest.
• C. It is a result of tissue hypoxia.
• D. It is characterized by cramping and weakness.

Correct answer: D

Rationale: Claudication is a symptom of peripheral vascular disease where there is an inadequate supply of oxygen to the muscles due to reduced blood flow. This mismatch between oxygen demand and supply leads to tissue hypoxia, resulting in cramping, weakness, and discomfort. Option D correctly states that claudication is characterized by cramping and weakness, making it the correct answer. Options A, B, and C are incorrect. Claudication occurs when oxygen demand exceeds supply, not the other way around as stated in Option A. Pain in claudication typically occurs with activity, not at rest as mentioned in Option B. While tissue hypoxia is a consequence of claudication, it is not the primary cause, making Option C incorrect.

3. A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?

• A. Diarrhea
• B. Metabolic acidosis
• C. Metabolic alkalosis
• D. Hyperactive bowel sounds

Correct answer: C

Rationale: In the scenario of persistent vomiting, the child is at risk of developing metabolic alkalosis due to the loss of hydrochloric acid. Vomiting leads to the loss of gastric acid, resulting in an imbalance that causes metabolic alkalosis. Metabolic acidosis is incorrect as it would occur in a child with diarrhea due to the loss of bicarbonate. While diarrhea can sometimes be associated with vomiting, in this case, the primary focus is on the effects of vomiting. Hyperactive bowel sounds are not typically associated with vomiting, making this choice less relevant to the situation described.

4. A 4-year-old child with acute glomerulonephritis is admitted to the hospital. The nurse identifies which client problem in the plan of care as the priority?

• A. Infection related to hypertension
• B. Injury related to loss of blood in urine
• C. Excessive fluid volume related to decreased plasma filtration
• D. Retarded growth and development related to a chronic disease

Correct answer: C

Rationale: In acute glomerulonephritis, the child experiences excessive accumulation of water and retention of sodium, leading to circulatory congestion and edema. Excessive fluid volume is a primary concern due to the disease process. Hypertension and infection are not directly related to acute glomerulonephritis; therefore, they are not the priority client problems. While hematuria (blood in urine) may occur, it typically does not lead to significant injury that takes precedence over excessive fluid volume. Acute glomerulonephritis is an acute condition, not chronic; therefore, retarded growth and development related to a chronic disease is not the priority issue. With proper management, most children recover completely without long-term growth and development issues.

5. A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?

• A. Blood sugar check
• B. CT scan
• C. Blood cultures
• D. Arterial blood gases

Correct answer: C

Rationale: The most likely test to be performed first in this scenario is blood cultures. Blood cultures are crucial to investigate the fever and rash symptoms in an unconscious patient. This test is used to detect foreign invaders like bacteria, yeast, and other microorganisms in the blood, which could indicate a blood infection (bacteremia). A positive blood culture result confirms the presence of bacteria in the blood. A blood sugar check (choice A) may be important but is less likely to be the first test in this context. A CT scan (choice B) and arterial blood gases (choice D) are generally not the initial tests performed to investigate a fever and rash with altered mental status.

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