Nursing Elites

1. A young adult male who is being seen at the employee health care clinic for an annual assessment tells the nurse that his mother was diagnosed with schizophrenia when she was his age and that life with a schizophrenic mother was difficult indeed. Which response is best for the nurse to provide?

• A. Ask the client if he is worried about becoming schizophrenic at the age his mother was diagnosed.
• B. Encourage the client to seek genetic counseling to determine his risk for mental illness.
• C. Inform the client that his mother’s schizophrenia has affected his psychological development.
• D. Tell the client that mental illness has a familial predisposition so he should see a psychiatrist.

Correct answer: B

Rationale: Genetic counseling can help assess risk and provide guidance for the client’s concerns about potential hereditary conditions.

2. A male client with diabetes mellitus takes NPH/regular 70/30 insulin before meals and azithromycin PO daily, using medication he brought from home. When the nurse delivers his breakfast tray, the client tells the nurse that he took his insulin but forgot to take his daily dose of azithromycin an hour before breakfast as instructed. What action should the nurse implement?

• A. Provide a PRN dose of an antacid to take with the azithromycin right after breakfast
• B. Offer to obtain a new breakfast tray in an hour so the client can take the azithromycin
• C. Instruct the client to eat his breakfast and take the azithromycin two hours after eating
• D. Tell the client to skip that day's dose and resume taking the azithromycin the next day

Correct answer: C

Rationale: Azithromycin should ideally be taken on an empty stomach; however, if taken after breakfast, it should not affect its efficacy. Instructing the client to eat his breakfast and take the azithromycin two hours after eating allows for proper absorption without compromising its effectiveness. Providing an antacid with azithromycin is not necessary in this case. Offering a new breakfast tray in an hour or skipping the dose is not the best course of action as it may lead to missed doses and potential effectiveness issues.

3. After successful resuscitation, a client is given propranolol and transferred to the Intensive Coronary Care Unit (ICCU). On admission, magnesium sulfate 4 grams IV in 250 ml D5W at one gram/hour. Which assessment findings require immediate intervention by the nurse?

• A. Dark amber urine draining via an indwelling catheter at a rate of 40 ml per hour
• B. Serum calcium of 9.0 mg/dl (2.2 mmol/L SI) and magnesium of 1.8 mg/dl or Eq/L (0.74 mmol/L SI)
• C. Sinus rhythm at 72 beats/minute and peripheral blood pressure of 99/62
• D. Respiratory rate of 10 breaths per minute

Correct answer: D

Rationale: The correct answer is D. A low respiratory rate of 10 breaths per minute is indicative of possible magnesium toxicity, which can be a serious condition requiring immediate intervention. It is a critical finding that needs prompt attention to prevent further complications. The other options are not as urgent: A - dark amber urine may indicate dehydration but does not require immediate intervention, B - serum calcium and magnesium levels are within normal limits, C - sinus rhythm and blood pressure values are also within normal range and do not require immediate action.

4. The nurse enters the room of a client who is awaiting surgery for appendicitis. The unlicensed assistive personnel (UAP) has helped the client to a position of comfort with the right leg flexed and has applied a heating pad to the client’s abdomen to relieve the client’s pain. Which action should the nurse implement first?

• A. Remove the heating pad.
• B. Reposition the client’s right leg.
• C. Monitor for signs of inflammation.
• D. Assess the client’s pain level.

Correct answer: A

Rationale: The correct action for the nurse to implement first is to remove the heating pad. Heating pads should not be used for suspected appendicitis as they can mask symptoms and potentially worsen inflammation. Choice B is not the priority as the position of comfort chosen by the UAP may be appropriate. Monitoring for signs of inflammation (Choice C) is important but not the initial action to address the immediate issue of the heating pad. Assessing the client's pain level (Choice D) can be done after removing the heating pad to evaluate the effectiveness of pain relief measures.

5. Four clients arrive on the labor and delivery unit at the same time. Which client should the nurse assess first?

• A. A 38-week primigravida who reports contractions occurring every 10 minutes
• B. A 39-week primigravida with a biophysical profile score of 5 out of 8
• C. A 41-week multigravida who is scheduled for induction of labor today
• D. A 36-week multigravida with a prescription for serial blood pressure

Correct answer: B

Rationale: The correct answer is B. A biophysical profile score of 5 out of 8 indicates potential fetal distress, necessitating immediate assessment to ensure the well-being of the fetus. The other options, while important, do not suggest an immediate threat to the fetus' health. The 38-week primigravida with contractions every 10 minutes may be in early labor, the 41-week multigravida scheduled for induction can be assessed after addressing the immediate concern, and the 36-week multigravida with serial blood pressure can be assessed after ensuring the client with potential fetal distress is stabilized.

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