Nursing Elites

1. A nurse is providing discharge instructions to a client who has a new prescription for codeine for cough suppression. What is the priority instruction?

• A. Avoid driving
• B. Drink plenty of fluids
• C. Move slowly when standing up
• D. Take with food

Correct answer: C

Rationale: The correct answer is to instruct the client to 'Move slowly when standing up.' Codeine can cause orthostatic hypotension, a drop in blood pressure when changing positions, leading to dizziness or fainting. By advising the client to move slowly when standing up, the nurse helps prevent falls or injuries due to sudden drops in blood pressure. Choices A, B, and D are important instructions as well but not the priority when considering the risk of orthostatic hypotension associated with codeine.

2. The patient experienced a surgical procedure, and Betadine was utilized as the surgical prep. Two days postoperatively, the nurse's assessment indicates that the incision is red and has a small amount of purulent drainage. The patient reports tenderness at the incision site. The patient's temperature is 100.5°F, and the WBC is 10,500/mm³. Which action should the nurse take first?

• A. Reevaluate the temperature and white blood cell count in 4 hours.
• B. Check which solution was used for skin preparation in surgery.
• C. Plan to change the surgical dressing during the shift.
• D. Utilize SBAR to notify the primary health care provider.

Correct answer: D

Rationale: The patient is showing signs of a possible surgical site infection, including redness, purulent drainage, tenderness, elevated temperature, and increased white blood cell count. These symptoms suggest the need for immediate action to address a potential complication. Utilizing SBAR to notify the primary health care provider is crucial as it allows for effective communication of the patient's condition and the need for further assessment and intervention. Reevaluating the temperature and white blood cell count later, checking the solution used for skin preparation, or planning to change the dressing do not address the urgent need for intervention and communication with the healthcare provider.

3. A healthcare provider is reviewing the medical record of a client who has a new prescription for cimetidine. Which of the following laboratory findings should the healthcare provider identify as the priority to report to the provider?

• A. Sodium 140 mEq/L
• B. WBC count 9,000/mm3
• C. Aspartate aminotransferase (AST) 50 units/L
• D. Fasting glucose 105 mg/dL

Correct answer: C

Rationale: An elevated AST level is indicative of liver damage, which is the priority finding to report to the provider when administering cimetidine. Elevated liver enzymes can be a sign of liver toxicity or damage. Monitoring liver function is crucial when using cimetidine, as it can sometimes lead to hepatotoxicity. The other laboratory findings are within normal ranges and not directly associated with cimetidine administration.

4. What is the most appropriate method for assessing a patient's pain level?

• A. Observe the patient's facial expressions.
• B. Use a standardized pain scale, such as 0-10.
• C. Ask the patient to rate their pain based on their mood.
• D. Ask the patient's family members to assess the pain.

Correct answer: B

Rationale: The most appropriate method for assessing a patient's pain level is to use a standardized pain scale, such as a 0-10 scale. This method provides an objective and consistent way to measure and communicate the intensity of pain experienced by the patient. Choice A, observing facial expressions, can be subjective and may not always accurately reflect the level of pain. Choice C, asking the patient to rate their pain based on their mood, may be influenced by various factors unrelated to pain. Choice D, involving the patient's family members in assessing the pain, is not ideal as pain is a subjective experience that should be reported by the patient themselves.

5. A county public health nurse is developing a list of interventions to address the three core functions of public health. Which of the following interventions should the nurse include as part of the assurance function?

• A. Use surveillance to investigate outbreaks of foodborne illness
• B. Monitor the incidence rates of varicella every 2 months
• C. Organize an immunization clinic for at-risk members of the community
• D. Educate the community about the health risks of alcohol use

Correct answer: C

Rationale: The correct answer is C: 'Organize an immunization clinic for at-risk members of the community.' This intervention is part of the assurance function in public health, as it ensures that the community has access to preventive health services. Choice A is related to the assessment function as it involves surveillance to investigate outbreaks. Choice B is also related to the assessment function since it involves monitoring incidence rates. Choice D is associated with the policy development function as it involves educating the community about health risks.

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