Nursing Elites

1. When discussing the child's wishes for future care, it is important for the nurse to first identify what the child knows about the disease and his prognosis. Factors such as the perceived severity of the illness will be significant in planning for end-of-life care. If the child does not understand the disease process or prognosis, the plan of care would not be effective or realistic. In addition, asking a child about desired interventions in the event of cardiac or respiratory arrest would not be an appropriate initial area of questioning. If the child does not understand the disease process, these questions may seem frightening or threatening. While exploring the child's belief about death would be important, it would not be the initial area of discussion and should be guided by the child rather than the nurse.

• A. What the child knows about the disease and his prognosis.
• B. How the child would like to handle the plan of care.
• C. What interventions the child would like in the event of cardiac or respiratory arrest.
• D. What the child believes about death.

Correct answer: A

Rationale: When discussing the child's wishes for future care, it is essential to first determine what the child understands about the disease and his prognosis. This information is crucial for planning appropriate end-of-life care. If the child lacks comprehension of the illness and its prognosis, any care plan discussed would be ineffective and unrealistic. Inquiring about desired interventions during cardiac or respiratory arrest is not the initial step, as it may cause distress if the child lacks understanding. While exploring the child's beliefs about death is significant, it should not be the primary focus initially and should be approached based on the child's readiness, not the nurse's agenda. Therefore, the correct first step is to assess what the child knows about the disease and his prognosis.

2. A 62-year-old female is being seen on a home visit by a nurse. The patient reports she has been taking Premarin for years. Which of the following would indicate an overdose?

• A. Lower extremity edema
• B. Sensory changes in the upper extremities
• C. Increased occurrence of fractures
• D. Decreased peripheral blood flow

Correct answer: A

Rationale: Lower extremity edema can indicate an overdose of Premarin. Premarin, an estrogen hormone replacement therapy, can cause fluid retention leading to edema in the lower extremities. Sensory changes in the upper extremities, increased occurrence of fractures, and decreased peripheral blood flow are not typically associated with an overdose of Premarin.

3. Which reported symptom would indicate a client with Addison's disease has received too much fludrocortisone (Florinef) replacement?

• A. Oily skin and hair
• B. Weight gain of 6 pounds in one week
• C. Loss of muscle mass in arms and legs
• D. Increased blood glucose level

Correct answer: B

Rationale: Fludrocortisone (Florinef) replacement in Addison's disease involves mimicking aldosterone to retain sodium and water. This retention can lead to weight gain due to increased fluid retention. Rapid weight gain, such as 6 pounds in one week, is a concerning sign of excessive fluid retention, indicating a potential overdose of fludrocortisone. Choices A, C, and D are incorrect because oily skin and hair, loss of muscle mass, and increased blood glucose levels are not specific symptoms of excessive fludrocortisone replacement in Addison's disease.

4. The chemotherapeutic agent 5-fluorouracil (5-FU) is ordered for a client as an adjunct measure to surgery. Which statement about chemotherapy is true?

• A. It is a local treatment affecting only tumor cells.
• B. It is a systemic treatment affecting both tumor and normal cells.
• C. It has not yet been proven an effective treatment for cancer.
• D. It is often the drug of choice because it causes few, if any, side effects.

Correct answer: B

Rationale: The correct answer is that chemotherapy is a systemic treatment affecting both tumor and normal cells. 5-FU, as an antimetabolic drug, inhibits DNA synthesis and interferes with cell replication systemically. It affects all rapidly growing cells, including malignant and normal ones. This drug is used as adjuvant therapy for various cancers. Choice A is incorrect because chemotherapy affects both tumor and normal cells, not just tumor cells. Choice C is incorrect as chemotherapy has been proven effective in treating cancer. Choice D is incorrect because chemotherapy often causes side effects like bone marrow depression, anorexia, stomatitis, nausea, and vomiting.

5. A violation of a patient's confidentiality occurs if two nurses are discussing client information in which of the following scenarios?

• A. With a physical therapist treating the patient
• B. With a social worker planning for discharge
• C. With another nurse on duty to plan for break time
• D. In the hallway outside the patient's room

Correct answer: D

Rationale: The correct answer is 'In the hallway outside the patient's room.' Discussing client information in a public area like a hallway can potentially breach patient confidentiality as it increases the risk of unauthorized individuals overhearing sensitive information. Choices A, B, and C involve discussing client information with other healthcare professionals in appropriate settings, which are more likely to maintain patient confidentiality compared to discussing in a public space like a hallway. Option D is the correct choice because it highlights a scenario where patient information is at higher risk of exposure to unauthorized individuals, hence violating patient confidentiality.

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