Nursing Elites

1. The teaching plan for gay or lesbian parents who want to disclose their homosexuality to their children should include all of the following instructions except:

• A. disclose the information before the child knows or suspects.
• B. be comfortable with your sexual preference first.
• C. have the discussion in a quiet place where interruptions are unlikely.
• D. explain how your relationship with the child changes because of the discussion

Correct answer: explain how your relationship with the child changes because of the discussion

Rationale: The correct answer is to explain how your relationship with the child changes because of the discussion. Children of gay and lesbian parents should be reassured that their relationship with their parent will not change due to the disclosure. Choices A, B, and C are all important aspects of the disclosure process. It is crucial to disclose the information before the child knows or suspects, be comfortable with your sexual preference first, and have the discussion in a quiet place to ensure a safe and open environment for communication. Explaining how the relationship with the child changes might create unnecessary anxiety or confusion. Children may have different reactions based on their age, understanding, and environment. Therefore, it is essential to maintain a sense of stability and security in the parent-child relationship while addressing any questions or concerns that may arise.

2. A nurse is preparing to test cranial nerve I. Which item does the nurse obtain to test this nerve?

• A. Coffee
• B. A tuning fork
• C. A wisp of cotton
• D. An ophthalmoscope

Correct answer: A wisp of cotton

Rationale: To assess the function of cranial nerve I (olfactory nerve), the nurse uses a wisp of cotton to test the sense of smell in a client who reports loss of smell. The nurse assesses the patency of the client's nostrils by occluding one nostril at a time and asking the client to sniff. Next, with the client's eyes closed, the nurse occludes one nostril and presents a non-noxious aromatic substance such as coffee, toothpaste, orange, vanilla, soap, or peppermint. Choice A, 'Coffee,' is incorrect because it is used to present non-noxious aromatic substances to assess cranial nerve I. Choice B, 'A tuning fork,' is used to assess the function of cranial nerve VIII (acoustic nerve). Choice D, 'An ophthalmoscope,' is used to assess the internal structures of the eye, not cranial nerve I.

3. The physician orders the antibiotics ampicillin (Omnipen) and gentamicin (Garamycin) for a newly admitted client with an infection. The nurse should:

• A. administer both medications simultaneously
• B. give the medications sequentially, and flush well between them
• C. ask the physician or pharmacy which medication to give first and how long to wait before giving the other drug
• D. start one medication now and begin the other medication in 2–4 hours

Correct answer: give the medications sequentially, and flush well between them

Rationale: The correct answer is to give the medications sequentially and flush well between them. Ampicillin has a pH of 8–10, while gentamicin has a pH of 3–5.5, making them incompatible when given together. Flushing well between drugs is necessary to prevent any potential interactions. Option A is incorrect because administering both medications simultaneously can lead to incompatibility issues. Option C is incorrect because the nurse should already be aware of the correct administration sequence and not need to consult the physician or pharmacy each time. Option D is incorrect because delaying the second medication by several hours can slow down the treatment of the client's infection, which is not ideal in this scenario.

4. How often should the intravenous tubing on total parenteral nutrition solutions be changed?

• A. every 24 hours
• B. every 36 hours
• C. every 48 hours
• D. every 72 hours

Correct answer: every 24 hours

Rationale: The correct answer is to change the intravenous tubing on total parenteral nutrition solutions every 24 hours. This frequency is necessary due to the high risk of bacterial growth associated with TPN solutions. Changing the tubing every 24 hours helps prevent contamination and bloodstream infections. Choices B, C, and D are incorrect because waiting longer intervals increases the risk of introducing harmful bacteria into the patient's system, leading to potentially severe complications.

5. A female client is seen in the clinic for a gynecological examination. The nurse begins collecting subjective data. Which topic does the nurse ask the client about first?

• A. Her sexual history
• B. Her menstrual history
• C. Her obstetrical history
• D. The presence of vaginal drainage

Correct answer: Her menstrual history

Rationale: The nurse should begin by asking the client about her menstrual history as it is usually nonthreatening. This information can provide insights into the client's reproductive health and any irregularities. Menstrual history is a common starting point for gynecological assessments and can help in understanding the client's overall health status. Asking about sexual history may be more sensitive and personal, not always appropriate to start with. Obstetrical history pertains to pregnancies and may not be relevant if the client has not been pregnant. Inquiring about the presence of vaginal drainage is important but is usually addressed after gathering more general information about the client's health.

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