Nursing Elites

1. What is the best teaching point for a client with left-leg weakness learning to use a cane?

• A. Use the cane on the weaker side
• B. Maintain two points of support on the floor at all times
• C. Advance the cane 30 to 45 cm with each step
• D. Advance the cane and the strong leg together

Correct answer: B

Rationale: The correct teaching point for a client with left-leg weakness learning to use a cane is to maintain two points of support on the floor at all times. This ensures better stability and support for the client while walking. Choice A is incorrect because the cane should be used on the stronger side to support the weaker leg. Choice C is incorrect as advancing the cane too far with each step may compromise balance. Choice D is incorrect because advancing the cane and the strong leg together may not provide adequate support for the weaker leg.

2. A client takes prednisone daily for the treatment of chronic asthma. The nurse should plan to monitor the client for which of the following adverse effects?

• A. Hyperglycemia
• B. Hypertension
• C. Gastric ulcer formation
• D. Diarrhea

Correct answer: C

Rationale: The correct answer is C: Gastric ulcer formation. Prednisone, a corticosteroid, increases the risk of gastric ulcer formation, especially with long-term use. While prednisone can also lead to hyperglycemia (choice A) and hypertension (choice B) as adverse effects, monitoring for gastric ulcer formation is a priority due to its association with corticosteroid therapy. Diarrhea (choice D) is not a common adverse effect of prednisone and is less likely compared to gastric ulcers.

3. A nurse assisting with a childbirth class is discussing nonpharmacological strategies used during labor. Which of the following statements by a client indicates an understanding of cutaneous stimulation?

• A. Apply counter-pressure for back pain
• B. Use deep breathing exercises
• C. Visualize the baby's head
• D. Use massage therapy

Correct answer: A

Rationale: The correct answer is A: 'Apply counter-pressure for back pain.' Counter-pressure involves applying pressure to the lower back to alleviate pain during labor. This technique is a form of cutaneous stimulation, which can help with pain relief. Choice B, deep breathing exercises, is a form of relaxation technique and does not directly involve cutaneous stimulation. Choice C, visualizing the baby's head, is a mental imagery technique and does not involve physical stimulation of the skin. Choice D, massage therapy, is a tactile stimulation technique but is not specifically focused on back pain relief through counter-pressure.

4. A client is learning to use a cane due to left-leg weakness. Which instruction is correct?

• A. Use the cane on the stronger side of the body
• B. Maintain two points of support on the floor at all times
• C. Advance the cane and the strong leg together
• D. Advance the cane 30 to 45 cm with each step

Correct answer: B

Rationale: The correct instruction when using a cane due to leg weakness is to maintain two points of support on the floor at all times. This provides stability and support while walking. Choice A is incorrect because the cane should be used on the weaker side to provide assistance. Choice C is incorrect as the cane and weak leg should move together for support. Choice D is incorrect as advancing the cane too far with each step may compromise balance and stability.

5. A client with hypokalemia is commonly expected to present with which of the following findings?

• A. Muscle weakness
• B. Nausea
• C. Tingling sensation
• D. Increased thirst

Correct answer: A

Rationale: The correct answer is A: Muscle weakness. Hypokalemia is characterized by low potassium levels in the blood, which can lead to muscle weakness. This occurs because potassium is essential for proper muscle function, and a deficiency can impair muscle strength. Nausea (choice B) is not a typical finding associated with hypokalemia. Tingling sensation (choice C) is more commonly linked to issues like nerve damage or poor blood circulation, rather than hypokalemia. Increased thirst (choice D) is not a direct symptom of hypokalemia; it is more commonly seen in conditions like diabetes or dehydration.

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