Nursing Elites

1. A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?

• A. Apply the patch to a different site each time.
• B. Change the patch every 72 hours.
• C. Avoid using additional heating pads over the patch.
• D. Remove the patch before showering.

Correct answer: B

Rationale: The most important instruction for the nurse to provide to a patient prescribed a fentanyl patch is to change the patch every 72 hours. This ensures consistent pain control and prevents complications. It is crucial to rotate the application sites to prevent skin irritation or reactions. Using additional heating pads over the patch should be avoided as it can increase the absorption of the medication, leading to overdose or adverse effects. Removing the patch before showering is not necessary as long as the patch is securely in place.

2. The client has received 250 ml of 0.9% normal saline through the IV line in the last hour. The client is now tachypneic and has a pulse rate of 120 beats/minute, with a pulse volume of +4. In addition to reporting the assessment findings to the healthcare provider, what action should the nurse implement?

• A. Discontinue the IV and apply pressure at the site.
• B. Decrease the saline to a keep-open rate.
• C. Increase the rate of the current IV solution.
• D. Change the IV fluid to 0.45% normal saline at the same rate.

Correct answer: B

Rationale: In this scenario, the client is showing signs of fluid overload with tachypnea and a high pulse rate. Decreasing the saline to a keep-open rate is appropriate to prevent further fluid volume excess. This action allows for IV access to be maintained while reducing the fluid administered, helping to manage the symptoms of fluid overload.

3. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

4. A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client?

• A. Glasgow Coma Scale
• B. Assess pulses, paresthesia, and paralysis distal to the right knee
• C. Assess pulses, paresthesia, and paralysis proximal to the right knee
• D. Optic nerve using an ophthalmoscope

Correct answer: B

Rationale: In this scenario, the nurse should assess pulses, paresthesia, and paralysis distal to the right knee to evaluate for neurovascular compromise. This assessment helps determine the perfusion and sensation of the lower extremity, which is crucial in identifying potential vascular or nerve damage that may be causing the client's symptoms.

5. The client has just been diagnosed with Addison's disease. Which clinical manifestation should the nurse expect to find?

• A. Hypertension and hyperglycemia.
• B. Hyperpigmentation and hypotension.
• C. Exophthalmos and tachycardia.
• D. Weight gain and fluid retention.

Correct answer: B

Rationale: Hyperpigmentation and hypotension are classic clinical manifestations of Addison's disease due to decreased cortisol production. Hyperpigmentation occurs due to elevated levels of ACTH, leading to increased melanin synthesis. Hypotension results from aldosterone deficiency, causing sodium loss and volume depletion.

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