Nursing Elites

1. A woman asks, "How much alcohol can I safely drink while pregnant?"? The nurse's best response is:

• A. "The amount of alcohol that is safe during pregnancy is unknown."?
• B. "Consuming one or two beers or glasses of wine a day is considered safe for a healthy pregnant woman."?
• C. "Drinking three or more drinks on any given occasion is the only harmful type of drinking during pregnancy."?
• D. "You can have a drink to help you relax and get to sleep at night."?

Correct answer: A

Rationale: The correct answer is, "The amount of alcohol that is safe during pregnancy is unknown."? This response is appropriate because there is no known safe amount of alcohol consumption during pregnancy. Consuming any amount of alcohol during pregnancy can pose risks to the developing fetus, leading to conditions like fetal alcohol syndrome, which is a combination of mental and physical abnormalities in infants. Choices B, C, and D are incorrect. Choice B suggests that consuming one or two drinks a day is safe during pregnancy, which is not supported by current medical guidelines. Choice C incorrectly states that only drinking three or more drinks on any given occasion is harmful, when in reality, any amount of alcohol can be harmful to the fetus. Choice D is inappropriate as it suggests that having a drink to relax and sleep is acceptable during pregnancy, which is not the case.

2. The nurse is assigning staff for the day. Which assignment should be given to the nursing assistant?

• A. Taking the vital signs of the 5-month-old with bronchiolitis
• B. Taking the vital signs of the 10-year-old with a 2-day postappendectomy
• C. Administering medication to the 2-year-old with periorbital cellulitis
• D. Adjusting the traction of the 1-year-old with a fractured tibia

Correct answer: B

Rationale: The most appropriate assignment for a nursing assistant is to take the vital signs of a stable patient. A 10-year-old with a 2-day postappendectomy is considered stable, and routine vital signs monitoring can be safely delegated to a nursing assistant. Clients with bronchiolitis, periorbital cellulitis, and a fractured tibia require more specialized care and assessment by a licensed nurse. Bronchiolitis involves an airway alteration, periorbital cellulitis indicates an infection, and a fractured tibia may raise concerns of abuse. Therefore, options A, C, and D are incorrect for delegation to a nursing assistant.

3. Narrow therapeutic index medications:

• A. are drug formulations with limited pharmacokinetic variability.
• B. have limited value and require no monitoring of blood levels.
• C. have less than a twofold difference in minimum toxic levels and minimum effective concentration in the blood
• D. have limited potency and side effects.

Correct answer: C

Rationale: The therapeutic index is the ratio between the median lethal dose and median effective dose of a drug, indicating the safety margin. Narrow therapeutic index medications have a small difference between minimum toxic levels and minimum effective concentration in the blood, making them high-risk drugs that require close monitoring to avoid toxicity. Choice A is incorrect because pharmacokinetics refer to drug absorption, distribution, metabolism, and elimination, not the therapeutic index. Choice B is incorrect because narrow therapeutic index drugs necessitate monitoring due to their narrow margin of safety. Choice D is incorrect because narrow therapeutic index drugs do not necessarily have limited potency but are characterized by a small window between efficacy and toxicity.

4. The nursing assistant hitting the client in the long-term care facility can be charged with:

• A. Negligence
• B. Tort
• C. Assault
• D. Malpractice

Correct answer: C

Rationale: Assault is the appropriate charge in this scenario. Assault involves physically striking or touching someone inappropriately. Negligence (Choice A) refers to failing to provide proper care for the client. Tort (Choice B) is a wrongful act committed against the client or their property. Malpractice (Choice D) is the failure to perform an act that should have been done or the improper performance of an act resulting in harm to the client. Since the nursing assistant physically struck the client, the charge of assault is most fitting.

5. During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:

• A. inquire about the possibility of sexual abuse.
• B. ask about the types of foods the child is eating.
• C. request to see the type of bottle used for feedings.
• D. question the parent about objects the child plays with.

Correct answer: A

Rationale: The correct answer is to inquire about the possibility of sexual abuse. Injuries to the soft palate such as bruising, abrasions, and petechiae can be signs of sexual abuse in infants. While oral sex may not leave significant physical evidence, these findings should raise suspicion. Option A is correct as it focuses on addressing potential abuse. Options B, C, and D are incorrect because the child's diet, the type of bottle used for feedings, and play objects are not likely related to the observed injuries. The presence of oral injuries suggests considering sexual abuse rather than other factors.

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