Nursing Elites

1. When supporting the psychosocial needs of a client experiencing negative side effects associated with chemotherapy, which intervention is most appropriate?

• A. Read the client's discharge instructions well in advance of dismissal
• B. Provide medications to reduce nausea and vomiting
• C. Give simple instructions about self-care while in the hospital
• D. Determine the levels of support from significant others

Correct answer: D

Rationale: When a client is experiencing negative side effects associated with chemotherapy, addressing their psychosocial needs is crucial. One effective intervention is to determine the levels of support from significant others. This involves assessing the family, spouse, or friends who can provide help and support to the client when healthcare providers are not present. By identifying and organizing these resources, the nurse can help alleviate fears about the future, prepare caregivers for the client's needs, and facilitate a smoother transition for the client upon discharge. Reading discharge instructions, providing medications, or giving self-care instructions, although important, do not directly address the psychosocial needs of the client during this challenging time.

2. Which of the following factors may alter the level of consciousness in a patient?

• A. Alcohol
• B. Electrolytes
• C. Infection
• D. All of the above may cause altered level of consciousness

Correct answer: D

Rationale: Various factors can lead to altered levels of consciousness in a patient. Alcohol consumption can depress the central nervous system and cause changes in consciousness. Electrolyte imbalances, such as hyponatremia or hypernatremia, can disrupt brain function and affect consciousness. Infections, especially those affecting the brain like encephalitis, can also lead to alterations in consciousness. Therefore, all of the choices provided - Alcohol, Electrolytes, and Infection - can potentially cause changes in the level of consciousness. Remember the acronym AEIOU-TIPPS to recall common causes of decreased level of consciousness, including Alcohol, Electrolytes, and Infection, among others.

3. Application - The nurse is caring for a patient who has the following labs: Creatinine 2.5mg/dL, WBC 11,000 cells/mL, and Hemoglobin of 12 g/dL. Based on this information, which of these orders would the nurse question?

• A. Administer 30 Units of Lantus Daily
• B. CT of the spine with contrast
• C. X-ray of the abdomen and chest
• D. Administer heparin subcutaneously 5,000 Units every 12 hours

Correct answer: B

Rationale: The correct answer is to question the order for a CT of the spine with contrast. The patient's elevated creatinine level of 2.5mg/dL indicates impaired kidney function. Contrast agents are nephrotoxic and can further compromise kidney function in patients with existing nephropathy. Therefore, it is crucial to avoid contrast-enhanced imaging studies in patients with impaired renal function. Choice A: Administering 30 Units of Lantus Daily is not contraindicated based on the provided lab values. Choice C: Ordering an X-ray of the abdomen and chest is not contraindicated based on the provided lab values. Choice D: Administering heparin subcutaneously at 5,000 Units every 12 hours is not contraindicated based on the provided lab values.

4. Which of these clients is likely to receive sublingual morphine?

• A. A 75-year-old woman in a hospice program
• B. A 40-year-old man who just had throat surgery
• C. A 20-year-old woman with trigeminal neuralgia
• D. A 60-year-old man who has a painful incision

Correct answer: A

Rationale: The correct answer is a 75-year-old woman in a hospice program. Sublingual morphine is commonly used in hospice care because patients may have difficulty swallowing, and intravenous access can be uncomfortable and not ideal for palliative care. Choice B, a 40-year-old man who just had throat surgery, is less likely to receive sublingual morphine as he may be able to swallow, and other pain management options may be more suitable. Choice C, a 20-year-old woman with trigeminal neuralgia, would typically require specific medications targeting neuropathic pain rather than sublingual morphine. Choice D, a 60-year-old man with a painful incision, may benefit from localized pain relief or other systemic pain management options, but sublingual morphine is not usually the first choice for this type of pain.

5. An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure should the nurse stress to the parents as they prepare to take their child home?

• A. Leave the diapers on to protect the surgical site.
• B. Avoid tub baths until the stent has been removed.
• C. Delay toilet training until the child has fully recovered.
• D. Encourage adequate fluid intake to maintain hydration.

Correct answer: B

Rationale: After surgical repair of hypospadias, the nurse should stress to the parents to avoid giving the child a tub bath until the stent has been removed. This precaution helps prevent infection and ensures proper healing of the surgical site. Leaving diapers on is important to protect the surgical site from contamination. Delaying toilet training is recommended to reduce stress on the child during the recovery period. Encouraging adequate fluid intake is crucial to maintain hydration and support the healing process.

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