Nursing Elites

1. A nurse is providing discharge teaching for a client who is postop following abdominal surgery. Which of the following behaviors should the nurse identify as increasing the client's risk for complications?

• A. Walking twice daily
• B. Suppression of the urge to cough
• C. Suppression of the urge to defecate
• D. Lack of ambulation

Correct answer: C

Rationale: The correct answer is C. Suppression of the urge to defecate postoperatively can lead to complications such as constipation, which can increase the risk of complications after abdominal surgery. Walking twice daily (choice A) is actually beneficial for preventing complications such as deep vein thrombosis. Suppression of the urge to cough (choice B) can lead to issues like atelectasis. Lack of ambulation (choice D) can also contribute to complications like pneumonia and blood clots.

2. A nurse is preparing to administer a pneumococcal vaccine. Which of the following should the nurse verify?

• A. Client's allergy to eggs
• B. Client's current medications
• C. Client's vaccination history
• D. Client's blood pressure

Correct answer: C

Rationale: The correct answer is C: Client's vaccination history. Before administering a pneumococcal vaccine, the nurse should verify the client's vaccination history to ensure they are due for the vaccine. Verifying the vaccination history helps prevent unnecessary vaccinations and ensures that the client receives the appropriate immunization at the right time. Choices A, B, and D are not directly related to the administration of the pneumococcal vaccine. Checking for allergies to eggs may be important for other vaccines, but it is not specifically relevant to pneumococcal vaccination. The client's current medications and blood pressure are important for general health assessment but are not directly related to verifying the need for a pneumococcal vaccine.

3. Before an amniocentesis, what action by the client will need to be completed?

• A. Increase fluid intake
• B. Empty the bladder
• C. Avoid eating for 12 hours
• D. Take a sedative

Correct answer: B

Rationale: Before an amniocentesis, the client should empty their bladder. This is necessary to reduce the risk of bladder puncture during the procedure. A full bladder can be in the path of the needle, increasing the risk of injury. Increasing fluid intake (choice A) is not necessary before an amniocentesis. Avoiding eating for 12 hours (choice C) is not a standard preparation for an amniocentesis. Taking a sedative (choice D) is not routinely required for this procedure.

4. A nurse is caring for a client who has been experiencing repeated tonic-clonic seizures over the course of 30 min. After maintaining the client’s airway and turning the client on their side, which of the following medications should the nurse administer?

• A. Diazepam IV
• B. Lorazepam PO
• C. Diltiazem IV
• D. Clonazepam PO

Correct answer: A

Rationale: In the scenario of a client experiencing prolonged seizures, such as status epilepticus, the priority is to administer a benzodiazepine to stop the seizure activity. Diazepam is the medication of choice for this situation due to its rapid onset of action and effectiveness in terminating seizures quickly. Lorazepam, although another benzodiazepine, is typically given through routes other than oral (PO) administration in emergency situations. Diltiazem is a calcium channel blocker used for cardiac conditions, not for seizure management. Clonazepam is a benzodiazepine, but it is usually not the first choice in the acute management of status epilepticus.

5. A client who is 32 weeks pregnant and has a diagnosis of placenta previa is receiving teaching from a nurse. Which of the following instructions should the nurse include?

• A. Limit physical activity
• B. Monitor fetal movements daily
• C. Call the healthcare provider if contractions begin
• D. All of the above

Correct answer: D

Rationale: Clients diagnosed with placenta previa are at an increased risk of bleeding and preterm labor. Therefore, it is essential for them to limit physical activity to prevent complications. Monitoring fetal movements daily helps in assessing the well-being of the fetus. Additionally, notifying the healthcare provider if contractions begin is crucial as it could be a sign of preterm labor. Therefore, all of the instructions (limiting physical activity, monitoring fetal movements, and calling the healthcare provider if contractions begin) are necessary for managing placenta previa effectively. Choices A, B, and C are all correct instructions for a client with placenta previa.

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