Nursing Elites

1. A nurse is planning care for a client who has a sealed radiation implant and is to remain in the hospital for one week. Which of the following should the nurse include in the plan of care?

• A. Remove dirty linens from the room after double-bagging them
• B. Wear a dosimeter film badge while in the client’s room
• C. Limit each visitor to one hour per day
• D. Ensure family members remain at least 3 feet from the client

Correct answer: B

Rationale: The correct answer is to wear a dosimeter film badge while in the client's room. Wearing a dosimeter helps monitor the cumulative radiation exposure of healthcare workers, ensuring their safety during care. Removing dirty linens, limiting visitor time, and maintaining a distance from the client are not directly related to radiation safety measures and are not necessary in this scenario.

2. A nurse is preparing to assist a provider with the insertion of a nontunneled percutaneous central venous catheter into a client’s subclavian vein. Which of the following actions should the nurse take?

• A. Position the client in a high-Fowler’s position
• B. Place the client in Trendelenburg position
• C. Place a rolled towel under the client’s neck
• D. Assist the client into a side-lying position

Correct answer: B

Rationale: The correct action for the nurse to take when assisting with the insertion of a nontunneled percutaneous central venous catheter into the subclavian vein is to place the client in Trendelenburg position. This position helps distend the veins and reduces the risk of air embolism during the insertion procedure. Option A, positioning the client in a high-Fowler’s position, would not be appropriate as it does not facilitate venous distention. Option C, placing a rolled towel under the client’s neck, is not directly related to the procedure and does not serve a specific purpose in this context. Option D, assisting the client into a side-lying position, is also not the correct choice as Trendelenburg position is preferred for this procedure to aid in vein distention.

3. A nurse is caring for a client prescribed levetiracetam. Which of the following should the nurse monitor?

• A. Liver function
• B. Blood glucose levels
• C. Serum creatinine
• D. Blood pressure

Correct answer: C

Rationale: The correct answer is C: Serum creatinine. Levetiracetam requires monitoring of renal function, specifically serum creatinine levels, as it is primarily eliminated by the kidneys. Monitoring liver function (Choice A) is not necessary for levetiracetam. Blood glucose levels (Choice B) are typically not affected by levetiracetam. While monitoring blood pressure (Choice D) is important in general patient care, it is not specifically required for clients prescribed levetiracetam.

4. A nurse is planning care for a client who has Alzheimer's disease and demonstrates confusion and wandering behavior. Which of the following should the nurse include in the plan of care?

• A. Place the client in seclusion when she is confused
• B. Request a prescription for PRN restraints when the client is wandering
• C. Dim the lighting in the client’s room
• D. Leave one side rail up on the client's bed

Correct answer: D

Rationale: The correct answer is to leave one side rail up on the client's bed. This action can help prevent falls while allowing the client to get up safely when needed, reducing the risk of injury from wandering. Placing the client in seclusion (Choice A) is not appropriate as it can lead to increased agitation and distress. Requesting restraints (Choice B) should be avoided as it can increase the risk of injuries and is not recommended for clients with Alzheimer's. Dimming the lighting (Choice C) may increase confusion and disorientation in clients with Alzheimer's disease.

5. A nurse is teaching a client about the use of nitrofurantoin. Which of the following should be included?

• A. It can cause a brown discoloration of urine
• B. It should be taken with food
• C. It has no side effects
• D. It is safe during pregnancy

Correct answer: A

Rationale: The correct answer is A. Nitrofurantoin can cause a harmless brown discoloration of urine. Choice B is also correct as it should be taken with food to enhance absorption. Choice C is incorrect as nitrofurantoin does have side effects, such as gastrointestinal disturbances. Choice D is incorrect as nitrofurantoin is not recommended during the last month of pregnancy due to potential risks to the fetus.

Similar Questions