Nursing Elites

1. The nurse assigns a UAP to assist with the personal care of a client experiencing an acute exacerbation of multiple sclerosis. Which instruction should the nurse provide the UAP?

• A. Assist the client with a hot bath
• B. Encourage self-care but allow rest periods
• C. Face the client directly when speaking
• D. Keep the head of the bed elevated at all times

Correct answer: B

Rationale: The correct instruction for the UAP to provide when assisting a client experiencing an acute exacerbation of multiple sclerosis is to encourage self-care but allow rest periods. Clients with multiple sclerosis often experience fatigue, so promoting self-care activities while ensuring they have adequate rest periods is crucial for symptom management and maintaining independence. Choice A is incorrect as hot baths can potentially exacerbate symptoms in clients with multiple sclerosis. Choice C is unrelated to the client's care needs during an acute exacerbation of multiple sclerosis. Choice D is not a priority instruction in this situation and may not directly impact the client's immediate care needs.

2. A male client with TB returns to the clinic for daily antibiotic injections for a urinary infection. The client has been taking anti-tubercular medications for 10 weeks and states he has ringing in his ears. Which prescribed medication should the PN report to the HCP?

• A. Pyridoxine with a B complex multivitamin
• B. Gentamicin 160 mg IM daily
• C. Rifampin 600 mg PO daily
• D. Isoniazid 300 mg PO daily

Correct answer: B

Rationale: The correct answer is B: Gentamicin 160 mg IM daily. Gentamicin is an aminoglycoside antibiotic that can cause ototoxicity, leading to ringing in the ears (tinnitus). This symptom should be reported to the HCP immediately, as it may indicate a need to adjust or discontinue the medication. Choice A, Pyridoxine with a B complex multivitamin, is not the cause of ototoxicity. Choices C and D, Rifampin and Isoniazid, are anti-tubercular medications but are not associated with causing ringing in the ears.

3. An older postoperative client has the nursing diagnosis 'impaired mobility related to fear of falling.' Which desired outcome best directs the PN's actions for the client?

• A. The client will ambulate with assistance every 4 hours
• B. The physical therapist will instruct the client in the use of a walker
• C. The client will use self-affirmation statements to decrease fear
• D. The PN will place a gait belt on the client prior to ambulation

Correct answer: C

Rationale: The correct answer is C. Using self-affirmation statements helps the client reduce fear and regain confidence in mobility, which is essential for improving impaired mobility. Choice A focuses more on the frequency of ambulation rather than addressing the fear of falling. Choice B involves the physical therapist and the use of a walker, which may not directly address the client's fear. Choice D is a safety measure but does not specifically target the client's fear of falling.

4. A female Native American client who is receiving chemotherapy places a native artifact, an Indian medicine wheel, in her hospital room. The HCP removes the medicine wheel and tells the client, 'This type of thing does not belong in the hospital.' Which intervention should the PN implement?

• A. Teach the client about the importance of adhering to the chemotherapy regimen
• B. Act as the client's advocate when addressing the issue with the HCP
• C. Consult with a Native American healer about the appropriate use of a medicine wheel
• D. Inform the HCP about the client's feelings of culture shock

Correct answer: B

Rationale: Acting as the client's advocate is the most appropriate intervention in this situation. Removing a culturally significant artifact without considering the client's beliefs and emotional needs can be distressing. By advocating for the client, the PN can ensure that the client's cultural practices are respected, which is crucial for her emotional and spiritual well-being during treatment. Choice A is incorrect because while chemotherapy adherence is important, it is not the most immediate concern in this scenario. The client's cultural needs and well-being take precedence. Choice C is incorrect because consulting with a Native American healer might not be necessary at this point and could delay addressing the immediate issue of advocating for the client's rights. Choice D is incorrect because simply reporting the client's feelings of culture shock to the HCP does not actively address the situation or advocate for the client's rights and cultural needs.

5. At the first dressing change, the PN tells the client that her mastectomy incision is healing well, but the client refuses to look at the incision and refuses to talk about it. Which response by the PN to the client's silence is best?

• A. You will feel better when you see that the incision is not as bad as you may think.
• B. It's OK if you don't want to look or talk about the mastectomy. I will be available when you're ready.
• C. Part of recovery is accepting your new body image, and you will need to look at your incision.
• D. Would you like me to call another nurse to be here while I show you the wound?

Correct answer: B

Rationale: Acknowledging the client's feelings and providing emotional support without pressuring them to look at the incision is important. Choice B is the best response as it respects the client's emotional readiness to confront their body image changes. The client's autonomy and emotional needs are prioritized in this response. Choice A may invalidate the client's feelings by assuming the incision is not as bad as they think, potentially dismissing their emotions. Choice C is insensitive as it imposes a particular view of recovery on the client, disregarding their current emotional state. Choice D may escalate the situation by suggesting the need for another nurse, which could make the client feel uncomfortable and pressured.

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