Nursing Elites

1. A patient refused a newly opened fentanyl patch. Which of the following actions should the nurse take?

• A. Ask another nurse to witness the disposal of the new patch
• B. Dispose of the patch in a sharps container
• C. Send the patch back to the pharmacy
• D. Document the refusal and remove the patch

Correct answer: A

Rationale: When a patient refuses a newly opened fentanyl patch, the nurse should ask another nurse to witness the disposal of the new patch. This action ensures accountability, proper protocol, and prevents any potential diversion or misuse of the medication. Disposing of the patch in a sharps container (Choice B) is not sufficient as it does not address the need for witness accountability. Sending the patch back to the pharmacy (Choice C) may not be appropriate without proper documentation and witness. Simply documenting the refusal and removing the patch (Choice D) may lack the necessary verification of proper disposal.

2. A nurse is planning care for a client who is postoperative following a laminectomy. Which of the following interventions should the nurse include in the plan of care?

• A. Elevate the client's legs while in bed.
• B. Reposition the client every 2 hours.
• C. Maintain bed rest for the first 24 hours postoperatively.
• D. Ambulate the client on the first postoperative day.

Correct answer: D

Rationale: Ambulating the client on the first postoperative day is crucial to prevent complications like deep vein thrombosis and aid in the recovery process. Elevating the legs while in bed can help with circulation but is not as effective in preventing complications related to immobility post-surgery. Repositioning every 2 hours is important for preventing pressure ulcers but does not directly address postoperative care. Maintaining bed rest for the first 24 hours postoperatively can increase the risk of complications associated with immobility, making early ambulation a more appropriate intervention.

3. A nurse is reviewing the facility's safety protocols concerning newborn abduction with the parent of a newborn. Which of the following statements indicates an understanding of the teaching?

• A. Staff will apply the identification band after the first bath.
• B. I will not make public announcements about my baby's birth.
• C. I can remove my baby's identification band as long as they are in my room.
• D. I can leave my baby in my room while walking in the hallway.

Correct answer: B

Rationale: The correct answer is B. Not making public announcements about the baby's birth is crucial in preventing newborn abduction as it avoids exposing personal information. Choice A is incorrect because the identification band should be applied immediately after birth, not after the first bath. Choice C is incorrect as the baby's identification band should never be removed by the parent. Choice D is incorrect as parents should not leave their baby unattended in the room while they are outside the room.

4. A client with gastroesophageal reflux disease (GERD) is receiving teaching from a nurse. Which of the following instructions should the nurse include?

• A. Lie down after meals to reduce discomfort.
• B. Limit fluid intake to 1 liter per day.
• C. Avoid eating spicy foods.
• D. Eat three large meals each day.

Correct answer: C

Rationale: The correct answer is C: 'Avoid eating spicy foods.' Spicy foods can exacerbate symptoms of GERD by irritating the esophagus and causing discomfort. It is important for clients with GERD to avoid spicy foods to help manage their condition. Choices A, B, and D are incorrect. A client with GERD should not lie down after meals as this can worsen symptoms, limiting fluid intake to only 1 liter per day may not be appropriate for everyone, and eating three large meals each day can put pressure on the stomach and worsen GERD symptoms.

5. A nurse is planning care for a client who is receiving total parenteral nutrition (TPN). Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the therapy?

• A. Serum calcium level
• B. Blood glucose level
• C. Serum albumin level
• D. Serum sodium level

Correct answer: C

Rationale: The correct answer is C, Serum albumin level. Monitoring the serum albumin level helps assess the nutritional effectiveness of total parenteral nutrition (TPN). Serum albumin is a protein that reflects the long-term nutritional status of a patient. Serum calcium level (choice A) is not directly related to TPN effectiveness. Blood glucose level (choice B) is important to monitor in diabetic patients but is not the primary indicator of TPN efficacy. Serum sodium level (choice D) is more related to fluid balance and electrolyte status rather than the effectiveness of TPN.

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