Nursing Elites

1. The nurse is caring for a client with cerebral palsy. The nurse should provide frequent rest periods because:

• A. Grimacing and writhing movements decrease with relaxation and rest.
• B. Hypoactive deep tendon reflexes become more active with rest.
• C. Stretch reflexes are increased with rest.
• D. Fine motor movements are improved.

Correct answer: A

Rationale: Frequent rest periods help to relax tense muscles and preserve energy in clients with cerebral palsy. This can lead to a decrease in grimacing and writhing movements, as relaxation and rest help to alleviate muscle tension. Choices B, C, and D are incorrect because they provide inaccurate information. Hypoactive deep tendon reflexes do not become more active with rest; stretch reflexes are not increased with rest in cerebral palsy patients, and fine motor movements are not necessarily improved solely by rest.

2. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:

• A. cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.
• B. have few, if any, side effects.
• C. are used to treat multiple types of cancer.
• D. are cell-cycle-specific agents.

Correct answer: A

Rationale: Alkylating agents, such as nitrogen mustards, are effective chemotherapeutic agents because they cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. This cross-linking interferes with DNA replication and transcription, leading to cell death. Choice B is incorrect because alkylating agents have numerous side effects, including alopecia, nausea, vomiting, and myelosuppression. Choice C is incorrect because while nitrogen mustards are used to treat multiple types of cancer like chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and breast and ovarian cancer, their effectiveness is primarily due to DNA cross-linkage. Choice D is incorrect because alkylating agents are non-cell-cycle-specific agents, meaning they can act on cells in any phase of the cell cycle, not just on cells that are actively dividing.

3. While walking in the hallway of an acute care unit of the hospital, the nurse overhears the change of shift report. What should the nurse do?

• A. Make the charge nurse on the unit aware of the situation so that they can take the necessary steps to maintain the confidentiality of the information being reported.
• B. Disregard the information because it changes quickly on the acute care unit and is outdated within 2-3 hours anyway.
• C. Return to their own unit and not disclose that confidential information has been overheard.
• D. Ignore the situation.

Correct answer: A

Rationale: To protect the confidentiality of the information being reported, the nurse should make the charge nurse on the unit aware of the situation. This allows the charge nurse to take necessary steps to maintain confidentiality and ensure that the information is communicated in an appropriate and private manner. Disclosing the situation to the charge nurse is essential to address any breaches in confidentiality and uphold professional standards of privacy and ethics. Disregarding the information, returning to their own unit without disclosure, or ignoring the situation altogether would not address the breach of confidentiality and could lead to further issues regarding patient privacy and trust.

4. During the history assessment of an 80-year-old client, which statement made by the client might indicate a possible fluid and electrolyte imbalance?

• A. "My skin is always so dry."?
• B. "I often use a laxative for constipation."?
• C. "I have always liked to drink a lot of iced tea."?
• D. "I sometimes have a problem with dribbling urine."?

Correct answer: B

Rationale: The correct answer is "I often use a laxative for constipation." Frequent use of laxatives can lead to diarrhea and electrolyte loss, indicating a possible fluid and electrolyte imbalance. Statements A, C, and D are not directly related to fluid and electrolyte imbalance. Statement A about dry skin may suggest dehydration, but it is less specific to electrolyte imbalance than the frequent use of laxatives. Statement C about drinking a lot of iced tea could potentially relate to fluid intake, but it doesn't directly indicate an imbalance. Statement D about dribbling urine is more indicative of a potential urinary issue rather than a fluid and electrolyte imbalance.

5. The nurse is assigned to care for an infant with physiologic jaundice. Which action by the nurse would facilitate elimination of the bilirubin?

• A. Increasing the infant's fluid intake
• B. Maintaining the infant's body temperature at 98.6°F
• C. Minimizing tactile stimulation
• D. Decreasing caloric intake

Correct answer: A

Rationale: Bilirubin is excreted through the kidneys, therefore increasing fluid intake can help facilitate its elimination. Maintaining the infant's body temperature is important for overall health but does not directly assist in eliminating bilirubin, making choice B incorrect. Choices C and D are irrelevant to bilirubin elimination in this scenario and do not address the specific issue of physiologic jaundice.

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