Nursing Elites

1. The client is visiting a home health client with osteoporosis. The client has a new prescription for alendronate (Fosamax). Which instruction should be given to the client?

• A. Rest in bed after taking the medication for at least 30 minutes
• B. Avoid rapid movements after taking the medication
• C. Take the medication with water only
• D. Allow at least 1 hour between taking the medicine and taking other medications

Correct answer: B

Rationale: When a client is prescribed alendronate (Fosamax), instructing them to avoid rapid movements after taking the medication is crucial to prevent esophageal irritation. Resting in bed after taking the medication for at least 30 minutes (choice A) is not necessary and can increase the risk of side effects. While taking the medication with water only (choice C) is generally recommended, the key instruction to prevent esophageal irritation is to avoid rapid movements. Allowing at least 1 hour between taking the medicine and other medications (choice D) is not specifically related to the administration of alendronate and is not the primary concern when giving instructions to the client.

2. Several clients are admitted to the emergency room following a three-car vehicle accident. Which clients can be assigned to share a room in the emergency department during the disaster?

• A. The schizophrenic client experiencing visual and auditory hallucinations and the client with ulcerative colitis
• B. The client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm
• C. A child with fixed and dilated pupils and his parents, and the client with a frontal head injury
• D. The client who arrives with a large puncture wound to the abdomen and the client with chest pain

Correct answer: B

Rationale: The correct answer is to assign the client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm to share a room. The pregnant client needs close monitoring due to the abdominal pain, and the client with facial lacerations and a broken arm requires immediate attention for wound care and possible fracture management. Choice A should not be assigned together as the schizophrenic client experiencing visual and auditory hallucinations needs a separate room for privacy and safety, and the client with ulcerative colitis may require isolation due to the risk of infection. Choice C is incorrect because the child with fixed and dilated pupils is likely in a critical condition and should be in a private room with parents, while the client with a frontal head injury needs a separate room for focused care. Choice D is also incorrect as the client with a large puncture wound to the abdomen needs immediate attention in a separate room, and the client with chest pain requires evaluation and monitoring in a separate setting as well.

3. The nurse suspects an elderly client has been the victim of abuse. The client denies abuse and declines assistance. The nurse's next action should be to:

• A. respect the client's decision to refuse assistance.
• B. report the incident to the authorities.
• C. arrange an appointment with the client's family.
• D. educate the client about available services.

Correct answer: D

Rationale: In cases where elderly clients deny abuse and refuse assistance, it is crucial for the nurse to respect their autonomy while also ensuring their safety. Educating the client about available services is the appropriate action as it empowers the client with information without imposing any decisions on them. It allows the client to make informed choices regarding their well-being. Reporting the incident to the authorities (Choice B) may be necessary if there is immediate danger, but in this scenario, the client denies abuse. Arranging an appointment with the client's family (Choice C) may not be appropriate without the client's consent or in cases where the family might be involved in the abuse. Simply doing nothing (Choice A) is not the best course of action as the nurse should still provide support and resources to the client.

4. Support-system enhancement includes all of the following except:

• A. determining the barriers to using support systems.
• B. discussing ways to help others who are concerned.
• C. exploring life problems of the support-team members.
• D. involving spouse, family, and friends in the care and planning.

Correct answer: C

Rationale: Support-system enhancement involves various strategies to strengthen the support system. Determining the barriers to using support systems, discussing ways to help others who are concerned, and involving spouse, family, and friends in the care and planning are all essential aspects of enhancing the support system. However, exploring the life problems of the support-team members is not directly related to enhancing the support system. This approach could potentially invade personal boundaries and may not be necessary for improving the support system, making it the correct answer in this case. Therefore, option C is the correct answer as it does not align with the appropriate methods of support-system enhancement.

5. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug might be absorbed. This process is known as:

• A. hepatic clearance.
• B. total clearance.
• C. enterohepatic cycling.
• D. first-pass effect.

Correct answer: C

Rationale: The correct answer is 'enterohepatic cycling.' This process involves drugs being excreted into bile, delivered to the intestines, reabsorbed into the circulation, and can prolong the drug's presence in the body. 'Hepatic clearance' (Choice A) refers to the amount of drug eliminated by the liver. 'Total clearance' (Choice B) is the sum of all types of clearance including renal, hepatic, and respiratory. 'First-pass effect' (Choice D) is the amount of drug absorbed from the GI tract and metabolized by the liver before entering circulation, reducing the amount of drug available for systemic circulation.

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