Nursing Elites

1. The nurse is preparing a client who had a BKA amputation for discharge to home. Which recommendations should the nurse provide this client?

• A. All of the above
• B. Inspect the skin for redness
• C. Use a residual limb shrinker
• D. Wash the stump with soap and water

Correct answer: A

Rationale: Proper care of the residual limb is essential in preventing complications like infection or poor healing. By choosing 'All of the above,' the nurse ensures that the client receives comprehensive care. Inspecting the skin for redness is crucial as it can help in early detection of infections. Using a residual limb shrinker helps reduce swelling and maintain proper shaping of the limb. Washing the stump with soap and water on a daily basis is important for hygiene and preventing infections. Therefore, all the recommendations (choices A, B, and C) are essential for the client's care, making choice A the correct answer. Choice D is incorrect as it does not encompass all the necessary recommendations for the client's care.

2. A client receiving IV heparin reports abdominal pain and tarry stools. What is the nurse's priority action?

• A. Prepare to administer protamine sulfate.
• B. Continue the heparin infusion and notify the healthcare provider.
• C. Monitor the client's vital signs and assess abdominal pain.
• D. Administer a PRN dose of morphine sulfate.

Correct answer: A

Rationale: The correct answer is to prepare to administer protamine sulfate. Abdominal pain and tarry stools are indicative of gastrointestinal bleeding, a serious side effect of heparin therapy. Protamine sulfate is the antidote for heparin and is used to reverse its effects in cases of bleeding. Continuing the heparin infusion (Choice B) is not appropriate when the client is experiencing signs of bleeding. Monitoring vital signs and assessing abdominal pain (Choice C) is important but not the priority when immediate action is required to address potential bleeding. Administering morphine sulfate (Choice D) is not the priority in this situation; addressing the underlying cause of bleeding takes precedence.

3. The nurse is conducting intake interviews of children at a city clinic. Which child is most susceptible to lead poisoning?

• A. An 8-year-old who lives in a housing project.
• B. A 2-year-old who plays on aging playground equipment.
• C. An adolescent who works in a paint factory.
• D. A 10-year-old with Type 1 diabetes.

Correct answer: B

Rationale: The correct answer is B. Young children, like the 2-year-old playing on aging playground equipment, are at higher risk of lead poisoning due to their hand-to-mouth behavior and exploration of their environment. Aging playground equipment may have lead-based paint that can be ingested by the child. While children living in housing projects are also at risk due to lead-based paint in older buildings, the 2-year-old child playing on potentially lead-contaminated playground equipment is the most susceptible in this scenario. The adolescent working in a paint factory may face occupational hazards related to lead exposure, but the immediate risk from environmental sources is higher for the 2-year-old. Type 1 diabetes in a 10-year-old is not directly linked to an increased susceptibility to lead poisoning.

4. The client is being taught about precautions with Coumadin therapy. The client should be instructed to avoid which over-the-counter medication?

• A. Non-steroidal anti-inflammatory drugs
• B. Cough medicines containing guaifenesin
• C. Histamine blockers
• D. Laxatives containing magnesium salts

Correct answer: A

Rationale: The correct answer is A: Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs can increase the risk of bleeding in clients taking Coumadin, which is an anticoagulant medication. Avoiding NSAIDs helps prevent potentially dangerous interactions with Coumadin. Choices B, C, and D are incorrect. Cough medicines with guaifenesin, histamine blockers, and laxatives containing magnesium salts do not typically have significant interactions with Coumadin therapy. Therefore, they are not the over-the-counter medications that the client needs to avoid while on Coumadin.

5. What is the expected outcome of prescribing a proton pump inhibitor to a client with a peptic ulcer?

• A. Promote healing of the gastric mucosa.
• B. Neutralize the effects of stomach acid.
• C. Inhibit the growth of Helicobacter pylori.
• D. Reduce gastric acid secretion.

Correct answer: D

Rationale: The correct answer is D: Reduce gastric acid secretion. Proton pump inhibitors (PPIs) work by reducing gastric acid secretion, which helps prevent further irritation of the gastric mucosa and allows ulcers to heal. While promoting healing of the gastric mucosa (Choice A) is an indirect outcome of reducing gastric acid secretion, the primary mechanism of PPIs is to lower acid levels. Choice B, neutralizing the effects of stomach acid, is typically associated with antacids, not PPIs. Inhibiting the growth of Helicobacter pylori (Choice C) is usually achieved with antibiotics, not PPIs.

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