Nursing Elites

1. An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report?

• A. Look at last quarter's hemoglobin and hematocrit to assess for dehydration.
• B. Look for an increase in today's LDH compared to the previous one to assess for possible liver damage.
• C. Expect to find an increase in today's APTT compared to last quarter's due to bleeding.
• D. Determine if there is a decrease in serum potassium due to renal compromise.

Correct answer: B

Rationale: When a client increases their daily doses of acetaminophen for joint pain, it raises concerns about possible liver damage due to acetaminophen overdose. LDH (Lactate Dehydrogenase) levels can indicate liver function, so comparing today's levels with previous ones can help assess for liver damage caused by acetaminophen overuse.

2. The client was recently diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease?

• A. Perform 15 minutes of physical activity at least three times per week.
• B. Avoid taking aspirin to treat pain or fever.
• C. Take multivitamins as prescribed and eat organic foods whenever possible.
• D. Maintain a healthy body weight.

Correct answer: B

Rationale: The correct answer is B. Avoiding aspirin is crucial in managing chronic gastritis as it can further irritate the stomach lining, leading to exacerbations of the condition. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase stomach acid production, potentially worsening gastritis symptoms. Therefore, the nurse should educate the client on using alternative pain or fever relief methods that are less likely to aggravate gastritis, such as acetaminophen.

3. A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva). Which instruction should the nurse include in the client's teaching?

• A. Use this medication only during acute exacerbations.
• B. Rinse your mouth after using the inhaler.
• C. Take this medication with food.
• D. Increase your fluid intake to at least 3 liters per day.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the teaching for a client prescribed tiotropium (Spiriva) is to rinse the mouth after using the inhaler. Rinsing the mouth helps prevent oral thrush, a common side effect of inhaled medications. This action reduces the risk of developing oral fungal infections, promoting better oral health for the client.

4. A male client in the day room becomes increasingly angry and aggressive when denied a day-pass. Which action should the nurse implement?

• A. Tell him he can have a day pass if he calms down.
• B. Put the client's behavior on extinction.
• C. Decrease the volume on the television set.
• D. Instruct the client to sit down and be quiet.

Correct answer: D

Rationale: Instructing the client to sit down and be quiet is a direct and assertive approach that can help de-escalate the situation safely. It sets clear boundaries and expectations for the client's behavior, which may help reduce agitation and aggression in this scenario. Offering a day pass if the client calms down (Choice A) might reinforce the aggressive behavior. Putting the client's behavior on extinction (Choice B) involves not reinforcing the behavior, but it may not directly address the immediate safety concern. Decreasing the volume on the television set (Choice C) does not address the client's behavior directly and may not effectively manage the escalating situation.

5. The healthcare provider prescribes 15 mg/kg of Streptomycin for an infant weighing 4 pounds. The drug is diluted in 25 ml of D5W to run over 8 hours. How much Streptomycin will the infant receive?

• A. 9 mg
• B. 18 mg
• C. 27 mg
• D. 36 mg

Correct answer: A

Rationale: To calculate the dosage, first, convert the weight from pounds to kg (4 lbs / 2.2 ≈ 1.82 kg). Then, multiply by the prescribed mg/kg (15 mg/kg * 1.82 kg ≈ 27.3 mg). However, since the question asks for the closest correct option, the infant will receive approximately 9 mg.

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