Nursing Elites

1. You are creating a teaching plan for a patient with newly diagnosed migraine headaches. Which key item should NOT be included in the teaching plan?

• A. Avoid foods that contain tyramine, such as alcohol and aged cheese.
• B. Avoid drugs such as Tagamet, nitroglycerin, and Nifedipine.
• C. Continue taking estrogen as prescribed by your physician.
• D. A potential side effect of medications is rebound headache.

Correct answer: C

Rationale: The correct answer is C: Continue taking estrogen as prescribed by your physician. Medications such as estrogen supplements may actually trigger a migraine headache attack. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy, and menopause, seem to trigger headaches in many women. Choices A and B are important to include in the teaching plan for a patient with migraines as avoiding foods containing tyramine and certain drugs can help prevent migraine triggers. Choice D is also relevant as it is essential for the patient to be aware of potential side effects of medications, including rebound headaches.

2. Which of the following is a true statement about assessing blood pressure by palpation?

• A. Only the diastolic blood pressure can be assessed through palpation.
• B. The palpation technique is most useful for infants and small children.
• C. Hypertension is a common condition that might need to be assessed through blood pressure palpation.
• D. Only the systolic blood pressure can be assessed through palpation.

Correct answer: D

Rationale: When assessing blood pressure by palpation, it is important to note that only the systolic blood pressure can be determined accurately using this method. Diastolic blood pressure cannot be reliably assessed through palpation. The palpation technique is particularly useful in situations where traditional blood pressure measurement methods are challenging, such as in infants, small children, or individuals with low blood pressure that is difficult to hear. Hypertension, a common condition characterized by elevated blood pressure, is typically assessed using auscultation rather than palpation. Therefore, the correct statement is that only the systolic blood pressure can be assessed through palpation.

3. A client with a new prescription for lithium carbonate for bipolar disorder is being educated by a nurse on early indications of toxicity. The nurse should include which of the following manifestations in the teachings?

• A. Constipation
• B. Polyuria
• C. Rash
• D. Tinnitus

Correct answer: B

Rationale: Polyuria is a crucial early indication of lithium toxicity. It results from the drug's effect on the kidneys, leading to increased urine output. This is a significant symptom to monitor as it can indicate potential toxicity. Constipation, rash, and tinnitus are not typically associated with early indications of lithium toxicity. Constipation is more commonly seen as a side effect of some medications, while rash and tinnitus are not specific indicators of lithium toxicity.

4. A nursing student is teaching a patient and family about epilepsy prior to the patient's discharge. For which statement should you intervene?

• A. "You should avoid consumption of all forms of alcohol."?
• B. "Wear your medical alert bracelet at all times."?
• C. "Protect your loved one's airway during a seizure."?
• D. "It's important to consult with your physician before taking over-the-counter medications."?

Correct answer: D

Rationale: The correct answer is, "It's important to consult with your physician before taking over-the-counter medications."? Patients with epilepsy should not take over-the-counter medications without medical advice due to potential interactions with antiepileptic drugs or triggering seizures. Choices A, B, and C are all appropriate statements for a patient with epilepsy, focusing on alcohol avoidance, wearing a medical alert bracelet, and airway protection during a seizure, respectively. Choice D is incorrect because patients with epilepsy need to be cautious about medications due to possible interactions or adverse effects, so consulting with a physician is crucial before taking over-the-counter medications.

5. The charge nurse is notified that the unit will be receiving an admission of a client from another bed in the hospital in order to make room for others being admitted through the emergency room. The unit is the Women's Health Center of the hospital. Which of the following patients would be most appropriate to be transferred to this unit?

• A. A 26-year-old woman who had a bowel resection
• B. A 40-year-old man who underwent a hernia repair
• C. A 31-year-old woman with septicemia and who is on a ventilator
• D. A 91-year-old man with Alzheimer's disease recovering from a fall

Correct answer: A

Rationale: When deciding on transferring patients between units in a hospital, it is essential to consider the appropriateness of the patient for the receiving unit. The Women's Health Center typically caters to female patients with gynecological or obstetric conditions that do not require intensive monitoring or specialized care. In this scenario, the most suitable patient for transfer to the Women's Health Center would be the 26-year-old woman who had a bowel resection, as her condition aligns more closely with the services provided in that unit. The other options, including a male patient, a critically ill patient on a ventilator, and an elderly patient with Alzheimer's disease, would not be appropriate for transfer to a Women's Health Center due to the specialized care they require, which may not align with the unit's focus and staffing capabilities.

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