Nursing Elites

1. Methotrexate is prescribed for a client with rheumatoid arthritis (RA) who is also taking aspirin. What is the best explanation for the nurse to provide as to why a second medication has been added?

• A. Methotrexate slows the disease progression while aspirin controls the symptoms.
• B. Methotrexate helps to reduce the side effects of aspirin.
• C. Methotrexate has fewer harmful side effects than aspirin.
• D. Methotrexate enhances the effect of aspirin.

Correct answer: A

Rationale: The correct answer is A. Methotrexate is a disease-modifying antirheumatic drug (DMARD) that slows the progression of rheumatoid arthritis (RA), while aspirin helps control symptoms such as pain and inflammation. Therefore, the combination of methotrexate and aspirin is beneficial in managing RA by addressing both disease progression and symptom control. Choices B, C, and D are incorrect because methotrexate is not added to reduce the side effects of aspirin, has different side effects compared to aspirin, and does not enhance the effect of aspirin.

2. During a home visit, the nurse assesses the skin of a client with eczema who reports that an exacerbation of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms?

• A. An old friend with eczema came for a visit.
• B. Recently received an influenza immunization.
• C. A grandson and his new dog recently visited.
• D. Corticosteroid cream was applied to eczema.

Correct answer: C

Rationale: The correct answer is C. Contact with the grandson's new dog could have introduced new allergens or irritants, exacerbating the eczema symptoms. Choice A is unrelated to the exacerbation of symptoms. Choice B, receiving an influenza immunization, is unlikely to directly cause an exacerbation of eczema symptoms. Choice D, applying corticosteroid cream, is a common treatment for eczema and would not likely be the cause of the exacerbation.

3. What should the nurse caring for a 6-year-old child with acute glomerulonephritis anticipate as the most challenging aspect of care to implement?

• A. Forced fluids
• B. Increased feedings
• C. Bed rest
• D. Frequent position changes

Correct answer: C

Rationale: The correct answer is C: Bed rest. During the acute phase of glomerulonephritis, bed rest is usually recommended. A diet of restricted fluid, sodium, potassium, and phosphate is initially required. Bed rest can be very challenging to implement with an active 6-year-old child. Forced fluids (choice A) may be necessary to maintain hydration. Increased feedings (choice B) may not be as difficult to implement as bed rest. Frequent position changes (choice D) may also be important but are not typically the most challenging aspect of care for a child with acute glomerulonephritis.

4. A male client with diabetes mellitus is transferred from the hospital to a rehabilitation facility following treatment for a stroke resulting in right hemiplegia. He tells the nurse that his feet are always uncomfortably cool at night, preventing him from falling asleep. Which action should the nurse implement?

• A. Provide a warming pad for his feet
• B. Medicate the client with a prescribed sedative.
• C. Use a bed cradle to keep the covers off his feet.
• D. Place warm blankets next to the client's feet.

Correct answer: D

Rationale: Placing warm blankets next to the client's feet is the most appropriate action to provide warmth and comfort. This method is safe and effective in addressing the client's complaint of uncomfortably cool feet at night. Providing a warming pad (Choice A) may pose a risk of burns or injury, especially for a client with decreased sensation due to diabetes. Mediating the client with a sedative (Choice B) does not address the underlying issue of cool feet and may not be necessary. Using a bed cradle (Choice C) to hold the covers off the feet does not directly address the client's need for warmth and comfort.

5. A client is receiving a secondary infusion of erythromycin 1 gram in 100 mL dextrose 5% in water (D5W) to be infused in 45 minutes. How many mL/hour should the nurse program the infusion pump?

• A. 100 mL/hour.
• B. 125 mL/hour.
• C. 133 mL/hour.
• D. 150 mL/hour.

Correct answer: C

Rationale: To infuse 100 mL in 45 minutes, the infusion rate should be set to 133 mL/hour (100 mL / 0.75 hours). This calculation is obtained by dividing the total volume to be infused by the total time for infusion (100 mL / 0.75 hours = 133 mL/hour). Therefore, choice C is the correct answer. Choices A, B, and D are incorrect because they do not accurately calculate the infusion rate required to deliver the medication within the specified time frame.

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