Nursing Elites

1. An 8-year-old child is placed in 90-90 traction for a fractured femur. The nurse notices that the weights are touching the foot of the bed. What action should the nurse take?

• A. No bowel movement for two days
• B. Mother helps reposition the child
• C. Ensure weights are not touching the foot of the bed
• D. Child wiggles toes freely when tickled

Correct answer: C

Rationale: The nurse should ensure that the weights in traction are not touching the foot of the bed. This is crucial to maintain proper alignment and effectiveness of the traction. When the weights touch the bed, it can compromise the traction's function and delay healing. Choices A, B, and D are incorrect as they do not address the issue of ensuring that the weights are not touching the bed, which is essential for the traction to work effectively.

2. Which of the following is a common side effect of opioid analgesics that the nurse should monitor for in patients?

• A. Diarrhea
• B. Hypertension
• C. Constipation
• D. Bradycardia

Correct answer: C

Rationale: Constipation is a common side effect of opioid analgesics due to the slowing of gastrointestinal motility. Opioids bind to receptors in the gastrointestinal tract, leading to decreased peristalsis and increased water absorption, resulting in constipation. Monitoring for constipation is crucial to prevent discomfort or complications like bowel obstruction. Diarrhea (Choice A) is not a common side effect of opioid analgesics. Hypertension (Choice B) and Bradycardia (Choice D) are not typically associated with opioid use.

3. Thirty minutes after receiving IV morphine, a postoperative client continues to rate pain as 7 on a 10-point scale. Which action should the PN implement first?

• A. Call healthcare provider to request a different analgesic
• B. Determine when morphine can be given again
• C. Implement complementary pain relief methods
• D. Observe dressing to determine the presence of bleeding

Correct answer: C

Rationale: The most appropriate action for the PN to implement first is to implement complementary pain relief methods. This includes repositioning the client, applying heat or cold packs, or using relaxation techniques. These strategies can provide additional pain relief before the next dose of medication is due or before seeking further instructions from the healthcare provider. Calling the healthcare provider immediately to request a different analgesic (Choice A) may not be necessary at this moment since other non-pharmacological methods can be attempted first. Determining when morphine can be given again (Choice B) is important but addressing the client's immediate pain relief takes precedence. Observing the dressing for bleeding (Choice D) is important but not the first priority when the client is experiencing unrelieved pain.

4. The PN is reviewing instructions for the use of pilocarpine eye drops with a client who has glaucoma. The client replies that the drops are used to anesthetize the eye if eye pain is experienced. What action should the PN implement?

• A. Document in the chart that the client understands the correct action and use of eye drops
• B. Reassure the client that the drops will not be needed often since eye pain in glaucoma is not common
• C. Reteach the client about the action of the eye drops to decrease pressure in the eyes
• D. Explain to the client that the eye drops do not anesthetize the eyes but reduce pressure

Correct answer: C

Rationale: Pilocarpine eye drops are used to reduce intraocular pressure in glaucoma, not to anesthetize the eye. The PN should reteach the client about the purpose of the medication to ensure proper use and understanding, which is crucial for effective treatment. Choice A is incorrect because just documenting understanding without addressing the client's misconception is not enough. Choice B is incorrect as it provides incorrect information about the purpose of the eye drops and may lead to further misunderstanding. Choice D is incorrect as it provides inaccurate information stating that the drops provide pain relief, which is not their primary purpose.

5. A client who had a right total shoulder replacement is being prepared for discharge. What should the nurse emphasize to the client to prevent complications?

• A. Avoid lifting objects with the right arm until cleared by the surgeon.
• B. Perform shoulder exercises to regain strength.
• C. Use a sling at all times, even during sleep.
• D. Apply heat to the shoulder to reduce stiffness.

Correct answer: A

Rationale: The correct answer is to avoid lifting objects with the right arm until cleared by the surgeon. After a total shoulder replacement, it is essential to protect the new joint to prevent dislocation or injury. Lifting heavy objects prematurely can lead to complications. While performing shoulder exercises is important for strength, they should be done as per the healthcare provider's instructions to avoid strain on the new joint. Using a sling at all times, as in choice C, is not necessary once the client has regained enough strength and mobility. Applying heat, as in choice D, may not be recommended post-surgery; cold therapy is often preferred to reduce swelling and pain.

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