Nursing Elites

1. A provider has written a do not resuscitate (DNR) order for a client who is comatose and does not have advance directives. A member of the client’s family says, 'I wonder when the doctor will tell us what’s going on.' Which of the following actions should the nurse take first?

• A. Request that the provider provide more information to the family.
• B. Refer the family to a support group for grief counseling.
• C. Offer to answer questions that family members have.
• D. Ask the family what the provider has discussed with them.

Correct answer: D

Rationale: The correct action for the nurse to take first is to ask the family what the provider has discussed with them. This allows the nurse to clarify any misunderstandings and ensures that the family is fully informed before providing further information. Option A is not the best choice because it assumes the need for more information without first understanding what has already been communicated. Option B is premature as the family may not be ready for grief counseling at this stage. Option C, although a good general practice, is not the most appropriate immediate action in this situation where clarifying existing information is crucial.

2. A nurse is caring for a client with a new prescription for metoprolol. Which of the following should the nurse monitor?

• A. Blood pressure
• B. Liver function
• C. Serum potassium levels
• D. Blood glucose

Correct answer: A

Rationale: Corrected Rationale: Metoprolol is a beta-blocker commonly used to treat conditions like hypertension and angina. As a beta-blocker, it primarily affects the cardiovascular system by reducing heart rate and blood pressure. Therefore, the nurse should monitor the client's blood pressure regularly to assess the drug's effectiveness and ensure that it is within the therapeutic range. Monitoring liver function, serum potassium levels, or blood glucose is not typically required for clients taking metoprolol, as its primary impact is on the heart and blood vessels, making choice A the most appropriate monitoring parameter.

3. During a skin assessment on a client with risk factors for skin cancer, a nurse should understand that a suspicious lesion is:

• A. Scaly and red
• B. Asymmetric with variegated coloring
• C. Firm and rubbery
• D. Brown with a wart-like texture

Correct answer: B

Rationale: The correct answer is B: Asymmetric with variegated coloring. An asymmetric lesion with variegated coloring, meaning different shades of color within the same lesion, is characteristic of melanoma, a type of skin cancer. This type of lesion should raise suspicions and prompt further evaluation. Choices A, C, and D do not typically represent characteristics of suspicious skin lesions associated with skin cancer. Lesions that are scaly and red (Choice A) may indicate other skin conditions like eczema or psoriasis. Firm and rubbery lesions (Choice C) are more suggestive of benign skin growths like dermatofibromas. Lesions that are brown with a wart-like texture (Choice D) are often indicative of seborrheic keratosis, a benign growth, rather than a suspicious lesion related to skin cancer.

4. A nurse is caring for a client who has been taking haloperidol for several years. Which of the following assessment findings should the nurse recognize as a long-term side effect of this medication?

• A. Lip-smacking
• B. Agranulocytosis
• C. Clang association
• D. Alopecia

Correct answer: A

Rationale: Lip-smacking is a symptom of tardive dyskinesia, a long-term side effect of antipsychotic medications like haloperidol, characterized by involuntary movements of the face and jaw. Agranulocytosis (Choice B) is a rare but serious side effect of some medications, characterized by a dangerously low white blood cell count. Clang association (Choice C) is a thought disorder characterized by the association of words based on sound rather than meaning. Alopecia (Choice D) refers to hair loss, which is not a known long-term side effect of haloperidol.

5. A nurse is caring for a client who is 38 weeks pregnant and has a history of herpes simplex virus 2. Which question is most appropriate for the nurse to ask?

• A. Have your membranes ruptured?
• B. How far apart are your contractions?
• C. Do you have any active lesions?
• D. Are you positive for beta strep?

Correct answer: C

Rationale: The most appropriate question for the nurse to ask is whether the client has any active herpes lesions. This is crucial because the presence of active lesions can necessitate a cesarean section to prevent transmission of the virus to the newborn. Asking about membrane rupture (choice A) is important but not directly related to the client's herpes simplex virus 2 status. Inquiring about the frequency of contractions (choice B) is relevant for assessing labor progression but does not address the immediate concern of herpes transmission. Asking about being positive for beta strep (choice D) is important for determining the need for prophylactic antibiotics during labor, but it is not directly related to the client's herpes simplex virus 2 status.

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