Nursing Elites

1. During a home visit to an elderly client with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, 'She sleeps most of the day and is up most of the night. I can't get a decent night's sleep anymore.' Which suggestions should the nurse make to the daughter?

• A. Ask the client's physician for a strong sleep medicine
• B. Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime
• C. Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day
• D. Promote relaxation before bedtime with a warm bath or relaxing music

Correct answer: B

Rationale: The correct answer is to establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. By creating a structured daily schedule, the client's natural sleep-wake cycle can be regulated, helping to address the issue of daytime sleeping and nighttime wakefulness. Option A, asking for a strong sleep medicine, may not address the underlying cause and can have potential side effects in the elderly. Option C, engaging in exercises when drowsy, may not be suitable for someone with dementia and could disrupt sleep patterns further. Option D, promoting relaxation before bedtime, is helpful but may not be sufficient to address the client's significant sleep issue.

2. A public health nurse working in a rural area is developing a program to improve health for the local population. Which of the following actions should the nurse plan to take?

• A. Provide anticipatory guidance classes to parents through public schools.
• B. Have a nurse from outside the community provide health lectures at the county hospital.
• C. Encourage rural residents to focus health spending on tertiary health interventions.
• D. Launch a media campaign to increase awareness about industrial pollution.

Correct answer: A

Rationale: Providing anticipatory guidance classes to parents through public schools is the most appropriate action for the public health nurse in a rural area. This approach allows the nurse to address early prevention strategies, which are crucial in promoting health in rural populations. Choice B is incorrect because having a nurse from outside the community may not fully understand the local needs and dynamics. Choice C is wrong as focusing health spending on tertiary interventions is not cost-effective or preventive. Choice D is also incorrect because while increasing awareness about industrial pollution is important, it may not directly address the health needs of the local rural population.

3. A nurse is reviewing the medical record of a client who is taking furosemide. Which of the following findings should the nurse report to the provider?

• A. Potassium level of 3.8 mEq/L
• B. Sodium level of 135 mEq/L
• C. Magnesium level of 1.6 mEq/L
• D. Calcium level of 8.5 mg/dL

Correct answer: C

Rationale: The correct answer is C. A magnesium level of 1.6 mEq/L is within the normal range, but monitoring potassium levels is crucial for clients taking furosemide. Furosemide can cause hypokalemia (low potassium levels), which can lead to adverse effects such as cardiac dysrhythmias. Sodium and calcium levels are not typically affected by furosemide, so they are not the priority findings to report to the provider in this case.

4. A nurse is caring for a client who has bipolar disorder and is experiencing acute mania. The nurse obtained a verbal prescription for restraints. Which of the following actions should the nurse take?

• A. Request a renewal of the prescription every 8 hours.
• B. Check the client's peripheral pulse rate every 30 minutes.
• C. Obtain a prescription for restraint within 4 hours.
• D. Document the client's condition every 15 minutes.

Correct answer: D

Rationale: In a situation where a verbal prescription for restraints is obtained for a client experiencing acute mania, the nurse should document the client's condition every 15 minutes. This frequent documentation allows for accurate monitoring of the client's condition, ensuring safety and compliance. Requesting a renewal of the prescription every 8 hours (Choice A) is not necessary as the focus should be on monitoring the client's condition. Checking the client's peripheral pulse rate every 30 minutes (Choice B) is not directly related to the need for restraints in this scenario. Obtaining a prescription for restraint within 4 hours (Choice C) is not a priority when a verbal prescription is already obtained and immediate action is needed for the client's safety.

5. A nurse is teaching a client who has multiple sclerosis (MS) about strategies to reduce fatigue. Which of the following instructions should the nurse include?

• A. Exercise to the point of exhaustion
• B. Rest as needed throughout the day
• C. Avoid physical activity
• D. Exercise only once per week

Correct answer: B

Rationale: The correct instruction the nurse should include is to 'Rest as needed throughout the day.' Fatigue is a common symptom of multiple sclerosis (MS), and adequate rest is essential to manage it effectively. Resting as needed helps conserve energy and prevent fatigue from worsening. Choices A, C, and D are incorrect. 'Exercise to the point of exhaustion' is not recommended as it can lead to increased fatigue. 'Avoiding physical activity' entirely is not advisable as appropriate exercise can help maintain strength and energy levels. 'Exercising only once per week' may not be sufficient to combat fatigue and maintain overall well-being in clients with MS.

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