Nursing Elites

1. A nurse who recently learned she is pregnant has just received client assignments for the day. Which client assignment should the nurse question as being inappropriate?

• A. A client with metastatic cancer who is receiving a continuous infusion of intravenous morphine sulfate
• B. A client with a solid-sealed cervical radiation implant
• C. A client with diarrhea for whom enteric precautions are in effect
• D. A client for whom contact precautions have been implemented and who requires frequent wound irrigations

Correct answer: B

Rationale: The correct answer is a client with a solid-sealed cervical radiation implant. Brachytherapy involves the implantation of a sealed radiation source within the targeted tumor tissue. A client with such an implant emits radiation as long as it is in place. Pregnant nurses should not care for clients with solid-sealed radiation implants due to the potential radiation exposure risk to the fetus. Clients under enteric precautions due to diarrhea, receiving a continuous infusion of intravenous morphine sulfate for cancer pain, or requiring contact precautions and frequent wound irrigations do not pose a risk to pregnant nurses and are appropriate assignments for them. Therefore, the nurse should question the assignment involving the client with the solid-sealed cervical radiation implant as it poses a risk to the fetus.

2. When managing nausea related to Morphine epidural analgesia, the nurse should administer:

• A. Indomethacin
• B. Codeine
• C. Ibuprofen
• D. Compazine

Correct answer: D

Rationale: When managing nausea related to Morphine epidural analgesia, Compazine is the appropriate medication to administer. Compazine, also known as prochlorperazine, is commonly used to treat nausea and vomiting. It works by affecting certain chemicals in the brain that trigger nausea and vomiting. Choices A, B, and C are incorrect because Indomethacin, Codeine, and Ibuprofen are not typically used to manage nausea associated with Morphine epidural analgesia.

3. The nurse is caring for a non-English speaking client. The surgeon has asked the nurse to hurry up and prepare the client for their scheduled procedure, which is running late. Which of the following is least appropriate?

• A. Explain to the client's family member that the procedure may be delayed further.
• B. Inform the surgeon that the procedure will be delayed further because getting a staff interpreter will take additional time.
• C. Allow the client's family member to serve as the interpreter.
• D. Ask if a phone-service interpreting service is available to expedite the client preparation.

Correct answer: C

Rationale: Allowing the client's family member to serve as the interpreter is the least appropriate option. It is not recommended to rely on family members for interpretation as they may not be impartial, accurate, or trained to handle sensitive medical information. This can lead to misunderstandings, breaches in confidentiality, and compromised care. Choice A is a better option as it involves communication with the family member to manage expectations. Choice B is also appropriate as it prioritizes the need for a professional interpreter to ensure accurate communication. Choice D is a valid option as it explores the possibility of using a phone-service interpreting service to facilitate communication efficiently.

4. Which NSAID is comparable to morphine in efficacy?

• A. Feldene
• B. Stodal
• C. Toradol
• D. Elavil

Correct answer: C

Rationale: The correct answer is Toradol. Toradol is the first injectable NSAID that has been found to be comparable to morphine in terms of efficacy. Feldene (choice A) is not known for being comparable to morphine in efficacy. Stodal (choice B) is a homeopathic cough syrup and not an NSAID. Elavil (choice D) is a tricyclic antidepressant and not an NSAID, so it is not comparable to morphine in efficacy. Therefore, Toradol is the most appropriate choice as it matches the description provided in the question.

5. All of the following interventions should be performed when fetal heart monitoring indicates fetal distress except:

• A. increase maternal fluids
• B. administer oxygen
• C. decrease maternal fluids
• D. turn the mother

Correct answer: C

Rationale: When fetal distress is indicated, interventions are aimed at improving oxygenation and blood flow to the fetus. Increasing maternal fluids helps improve blood flow and oxygen delivery, administering oxygen increases oxygenation levels, and turning the mother can help optimize fetal oxygenation. Decreasing maternal fluids would negatively impact blood volume and can worsen fetal distress, making it the exception among the listed interventions. Therefore, decreasing maternal fluids should not be performed when fetal distress is present.

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