Nursing Elites

1. The nurse is teaching a client about sleep and gives background information on normal sleep patterns. Which of the following substances promotes sleep?

• A. serotonin
• B. cortisol
• C. alcohol
• D. narcotics

Correct answer: A

Rationale: Serotonin is a substance found in the body that promotes sleep. It plays a role in the synthesis of a hypnogenic factor that directly induces sleep. Cortisol is a stress hormone that can disrupt sleep patterns. Alcohol can disrupt REM sleep and negatively impact sleep quality. Narcotics, like alcohol, can interfere with sleep architecture and lead to poor quality sleep. Therefore, the correct answer is serotonin as it is associated with promoting sleep, while the other substances listed can have negative effects on sleep patterns.

2. A nurse who recently learned she is pregnant has just received client assignments for the day. Which client assignment should the nurse question as being inappropriate?

• A. A client with metastatic cancer who is receiving a continuous infusion of intravenous morphine sulfate
• B. A client with a solid-sealed cervical radiation implant
• C. A client with diarrhea for whom enteric precautions are in effect
• D. A client for whom contact precautions have been implemented and who requires frequent wound irrigations

Correct answer: B

Rationale: The correct answer is a client with a solid-sealed cervical radiation implant. Brachytherapy involves the implantation of a sealed radiation source within the targeted tumor tissue. A client with such an implant emits radiation as long as it is in place. Pregnant nurses should not care for clients with solid-sealed radiation implants due to the potential radiation exposure risk to the fetus. Clients under enteric precautions due to diarrhea, receiving a continuous infusion of intravenous morphine sulfate for cancer pain, or requiring contact precautions and frequent wound irrigations do not pose a risk to pregnant nurses and are appropriate assignments for them. Therefore, the nurse should question the assignment involving the client with the solid-sealed cervical radiation implant as it poses a risk to the fetus.

3. An advance directive is written and notarized according to law in the state of Colorado. This document is legal and binding:

• A. internationally.
• B. in the state of Colorado only.
• C. in the continental United States.
• D. in the county of origination only.

Correct answer: B

Rationale: The correct answer is 'in the state of Colorado only.' Advance directive protocols and documents are specific to each state's laws and regulations. Choice A is incorrect as advance directives are not universally recognized internationally. Choice C is incorrect as the legal validity of an advance directive is limited to the state in which it was created. Choice D is incorrect as the legal reach of an advance directive typically extends throughout the state of origination, not just the county.

4. Which of these clients should the LPN/LVN see first?

• A. a client with a newly placed NG tube who is complaining of pain around the face and a plugged nose
• B. a post-op prostatectomy client who complains of bladder spasms and blood in his foley bag
• C. a client in an arm cast who is 2 days post-op and reports feelings of numbness and tingling in her affected arm
• D. a client newly diagnosed with Hepatitis A who reports stomach pain and itchy skin

Correct answer: C

Rationale: Numbness and tingling hours or days after a cast is applied may indicate compartment syndrome and should be reported to a medical provider right away. This is a potential emergency situation that requires immediate attention to prevent complications. The other options present expected or typical symptoms related to their diagnosis, which do not require immediate intervention. Complaints related to a newly placed NG tube such as pain around the face and a plugged nose may require assessment and intervention but are not as urgent as potential compartment syndrome. Bladder spasms and blood in the foley bag post-prostatectomy are common postoperative issues that can be addressed after the client in the arm cast with potential compartment syndrome is seen. Stomach pain and itchy skin in a client with Hepatitis A are common symptoms of the condition and do not indicate an emergency situation.

5. When a client is having a seizure and their blood oxygen saturation drops from 92% to 82%, what should the nurse do first?

• A. Open the airway.
• B. Administer oxygen.
• C. Suction the client.
• D. Check for breathing.

Correct answer: A

Rationale: When a client is experiencing a seizure and their blood oxygen saturation drops, the priority action for the nurse is to open the airway. Ensuring a clear airway is essential to maintain oxygenation during a seizure episode. Administering oxygen may be necessary but is secondary to ensuring a patent airway. Suctioning the client should only be done if there is an airway obstruction. Checking for breathing is important, but opening the airway takes precedence to support ventilation and oxygenation.

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