Nursing Elites

1. The nurse is assisting the RN with discharge instructions for a client with an implantable defibrillator. What discharge instruction is essential?

• A. "You can eat food prepared in a microwave."?
• B. "You should avoid moving the shoulder on the side of the defibrillator site for 6 weeks."?
• C. "You should use your cellphone on your right side."?
• D. "You will be able to fly on a commercial airliner with the defibrillator in place."?

Correct answer: C

Rationale: The essential discharge instruction for a client with an implantable defibrillator is to use any battery-operated machinery on the opposite side, including cellphones. This is to prevent interference with the device. Additionally, the client should monitor their pulse rate and report any dizziness or fainting, which could indicate issues with the defibrillator. Choices A, B, and D are incorrect because clients with implantable defibrillators can eat food prepared in the microwave, move their shoulder on the affected side after the initial healing period, and are allowed to fly on commercial airliners with the defibrillator in place.

2. A health care worker is concerned about a new mother being overwhelmed by caring for her infant. What should the health care worker do?

• A. Immediately contact child protective services.
• B. Provide the mother with literature about child care.
• C. Consult a therapist to help the mother work out her fears.
• D. Refer the mother to parenting classes.

Correct answer: D

Rationale: When a health care worker is concerned about a new mother being overwhelmed by caring for her infant, the best course of action is to refer the mother to parenting classes. Prevention of child abuse is focused on educating parents on how to care for their child and handle the demands of infant care. By attending parenting classes, the mother can build self-confidence, self-esteem, and coping skills. Parenting classes help parents understand the developmental needs of their children and learn effective ways to manage their home environment. Additionally, these classes provide parents with increased social contacts and knowledge about community resources. Contacting child protective services (choice A) should not be the immediate action as there is no indication of abuse. Providing literature about child care (choice B) may not be as effective as hands-on parenting classes. Consulting a therapist (choice C) may be beneficial, but addressing parenting skills through classes is more appropriate in this scenario.

3. When questioning an elder about suspected abuse, how should the nurse keep the questions?

• A. Nonjudgmental.
• B. Probing.
• C. Confrontational.
• D. Indirect.

Correct answer: A

Rationale: When questioning an elder about suspected abuse, the nurse should keep the questions nonjudgmental. This approach helps the elder feel safe and more willing to share information. Probing questions might be perceived as invasive, confrontational questions can lead to defensiveness and denial, and indirect questions may not elicit the necessary information, resulting in confusion or misinterpretation.

4. When planning care of a client who has been diagnosed with Amphetamine Abuse, the nurse should use the knowledge that:

• A. Amphetamines increase energy by increasing dopamine levels at neural synapses.
• B. Amphetamines have a low risk of tolerance or addiction.
• C. Amphetamines produce a 10-20-second rush followed by a 2-4-hour high.
• D. Addiction to barbiturates and amphetamines is rare because they have opposite effects.

Correct answer: A

Rationale: The correct answer is that amphetamines increase energy by increasing dopamine levels at neural synapses. Amphetamines cause the release of norepinephrine and dopamine from storage vesicles into the synapse, leading to increased stimulation. It is important to note that clear patterns of tolerance and withdrawal have not been described with amphetamines. Choice B is incorrect as prolonged or excessive use of amphetamines can lead to psychosis, indicating a potential for addiction. Choice C is incorrect as the duration of the effects of amphetamines is typically longer than 2-4 hours. Choice D is incorrect as addiction to amphetamines is not rare; in fact, drug cravings are common and can lead to relapse, indicating a significant risk of addiction.

5. The client is being assessed for possible pernicious anemia. Which finding would support this diagnosis?

• A. A weight loss of 10 pounds in 2 weeks
• B. Complaints of numbness and tingling in the extremities
• C. A red, beefy tongue
• D. A hemoglobin level of 12.0 g/dL

Correct answer: C

Rationale: The correct answer is a red, beefy tongue, which is characteristic of pernicious anemia due to the atrophy of the papillae on the tongue. This finding is known as glossitis. A red, beefy tongue is a classic sign of pernicious anemia. Choice A, weight loss of 10 pounds in 2 weeks, is non-specific and not a typical finding in pernicious anemia. Choice B, complaints of numbness and tingling in the extremities, are more indicative of peripheral neuropathy, a common symptom of vitamin B12 deficiency, which can be seen in pernicious anemia. Choice D, a hemoglobin level of 12.0 g/dL, falls within the normal range and does not specifically point towards pernicious anemia, which is characterized by low hemoglobin levels due to impaired absorption of vitamin B12.

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