Nursing Elites

1. A patient with rheumatoid arthritis is prescribed methotrexate. What should the nurse include in the patient teaching?

• A. Take folic acid supplements as prescribed.
• B. Avoid alcohol completely.
• C. Expect to see immediate results.
• D. Limit fluid intake to 1 liter per day.

Correct answer: A

Rationale: Patients prescribed methotrexate should be advised to take folic acid supplements as prescribed. Methotrexate can deplete folic acid levels, leading to side effects. By taking folic acid supplements as directed, the patient can reduce the risk of experiencing adverse effects associated with methotrexate therapy. It is important to note that the effects of methotrexate may not be immediate, so realistic expectations should be set with the patient. Alcohol should be avoided while taking methotrexate due to potential interactions and increased risk of liver toxicity. There is no specific recommendation to limit fluid intake to 1 liter per day in relation to methotrexate therapy.

2. A client with type 1 diabetes mellitus is experiencing nausea and vomiting. What advice should the nurse give regarding insulin administration?

• A. Skip your insulin dose until you can eat.
• B. Take your insulin as prescribed, but monitor your blood glucose closely.
• C. Reduce your insulin dose by half.
• D. Only take your long-acting insulin.

Correct answer: B

Rationale: The correct advice for a client with type 1 diabetes mellitus experiencing nausea and vomiting is to take insulin as prescribed but monitor blood glucose closely. It is essential to continue insulin therapy even if not eating normally to prevent complications from high blood sugar levels. Skipping insulin doses can lead to dangerous fluctuations in blood glucose levels. Reducing the insulin dose without proper guidance can also result in uncontrolled blood sugar. Taking only long-acting insulin may not provide adequate coverage for mealtime blood sugar elevation. Therefore, the best course of action is to take prescribed insulin doses while closely monitoring blood glucose levels.

3. A client with hypertension is receiving dietary education from a nurse. Which recommendation should the nurse include?

• A. Increase your intake of saturated fats.
• B. Limit your sodium intake to less than 2 grams per day.
• C. Avoid foods high in potassium.
• D. Consume at least three alcoholic beverages daily.

Correct answer: B

Rationale: The correct recommendation for a client with hypertension is to limit sodium intake to less than 2 grams per day. High sodium intake can worsen hypertension by increasing blood pressure. Choices A, C, and D are incorrect. Increasing saturated fats (Choice A) can be detrimental to heart health and exacerbate hypertension. Avoiding foods high in potassium (Choice C) is not recommended as potassium-rich foods can actually be beneficial for managing blood pressure. Consuming three alcoholic beverages daily (Choice D) can also have a negative impact on blood pressure and overall health.

4. A client with chronic obstructive pulmonary disease (COPD) is receiving prednisone (Deltasone). Which side effect should the nurse monitor for?

• A. Hypoglycemia
• B. Infection
• C. Hypotension
• D. Weight loss

Correct answer: B

Rationale: The correct answer is B: Infection. Prednisone is an immunosuppressant medication commonly used in COPD to reduce inflammation. Due to its immunosuppressive effects, clients are at an increased risk of developing infections. Therefore, nurses should closely monitor clients receiving prednisone for signs and symptoms of infections to provide timely interventions.

5. The community mental health nurse is planning to visit four clients with schizophrenia today. Which client should the nurse see first?

• A. The mother who took her children from school because aliens were after them.
• B. The young man who has a history of substance abuse and no telephone.
• C. The newly diagnosed client who needs to be evaluated for medication compliance.
• D. The young woman who believes she is to blame for her recent miscarriage.

Correct answer: A

Rationale: The mother who took her children from school due to delusions of aliens poses a significant risk to her children and herself. This situation requires immediate attention to ensure the safety and well-being of all involved. Choice B is concerning due to the history of substance abuse, but the immediate risk to life and safety as in Choice A takes precedence. Choice C, although important, does not present an immediate danger as the delusional belief of aliens. Choice D, while emotionally distressing, does not pose an immediate threat as the situation described in Choice A.

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