Nursing Elites

1. A 45-year-old woman is prescribed ropinirole (Requip) for Parkinson's Disease. The patient is living at home with her daughter. The nurse is most concerned about which side effect of ropinirole?

• A. Slurred speech
• B. Sudden dizziness
• C. Mask-like facial expression
• D. Stooped posture

Correct answer: B

Rationale: The correct answer is 'Sudden dizziness.' Dizziness and orthostatic hypotension are serious adverse effects of ropinirole that can lead to an increased risk of falls. Ropinirole belongs to the drug class of dopamine agonists, which mimic dopamine in the brain (Parkinson's Disease is characterized by a lack of dopamine). 'Slurred speech' is not a common side effect of ropinirole. 'Mask-like facial expression' and 'Stooped posture' are more associated with the progression of Parkinson's Disease itself rather than a side effect of ropinirole.

2. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

• A. Observe for distended neck veins.
• B. Auscultate for crackles in the lungs.
• C. Palpate for heaves or thrills over the heart.
• D. Review hemoglobin and hematocrit values.

Correct answer: A

Rationale: To evaluate the effectiveness of therapies for cor pulmonale and right-sided heart failure, observing for distended neck veins would be the most appropriate assessment. Cor pulmonale is characterized by right ventricular failure due to pulmonary hypertension, leading to clinical manifestations such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness. These signs indicate increased central venous pressure and right heart strain, which can be assessed by observing for distended neck veins. Auscultating for crackles in the lungs is more indicative of left-sided heart failure rather than right-sided heart failure. Heaves or thrills over the heart are not typically associated with cor pulmonale. Reviewing hemoglobin and hematocrit values may show elevations due to chronic hypoxemia and polycythemia in cor pulmonale, but these values alone do not directly evaluate the immediate effectiveness of the prescribed therapies on the patient's condition.

3. A client with Multiple Sclerosis reports a constant, burning, tingling pain in the shoulders. The nurse anticipates that the physician will order which medication for this type of pain?

• A. alprazolam (Xanax)
• B. Corticosteroid injection
• C. gabapentin (Neurontin)
• D. hydrocodone/acetaminophen (Norco)

Correct answer: C

Rationale: For neuropathic pain associated with conditions like Multiple Sclerosis, medications like gabapentin, an anticonvulsant, are commonly used. Gabapentin helps in managing nerve pain by stabilizing electrical activity in the brain and nervous system. Alprazolam is a benzodiazepine used for anxiety and not primarily indicated for neuropathic pain. Corticosteroid injections are more suitable for inflammatory conditions like arthritis, not for neuropathic pain. Hydrocodone/acetaminophen is an opioid combination used for moderate to severe pain, but it is not the first-line choice for neuropathic pain.

4. A patient presents to the office with a pencil that has completely penetrated the palm of her hand. Which of the following treatments would be BEST in this situation?

• A. Assist the doctor while he sedates the patient and removes the pencil from her hand.
• B. Have the patient gently pull the pencil out of her hand and assist the physician with stitches.
• C. Wrap a gauze around the pencil, securing it as much as possible until the patient can get to a local emergency room.
• D. Tell the patient to go to the local emergency room. With a doctor's order, give the patient some aspirin for the pain.

Correct answer: C

Rationale: Penetrating wounds that leave an object behind may have damaged important blood vessels. Removing the object may lead to significant bleeding. The correct approach is to gently wrap the wound with the object in place to help control bleeding and prevent further injury. The patient should be taken promptly to the nearest emergency room where healthcare professionals can safely and appropriately remove the object and provide necessary treatment. Choice A is incorrect because removing the pencil without proper medical evaluation can worsen the injury. Choice B is incorrect because pulling out the object can cause additional damage and bleeding. Choice D is incorrect because giving aspirin without knowing the extent of the injury and causing potential drug interactions can be harmful.

5. What intervention should the nurse implement while a client is having a grand mal seizure?

• A. Open the jaw and place a bite block between the teeth
• B. Try to place the client on his side
• C. Restrain the client to prevent injury
• D. Place pillows around the client

Correct answer: B

Rationale: During a grand mal seizure, the client is at risk of injury due to severe, involuntary muscle spasms and contractions. It is crucial for the nurse to avoid restraining the client or inserting objects into their mouth, as these actions may lead to further harm. Placing the client on their side can help facilitate the drainage of oral secretions and assist in maintaining an open airway, reducing the risk of aspiration. Restraint should be avoided as it can exacerbate muscle contractions and increase the risk of injury. Placing pillows around the client may not provide adequate support or protection during the seizure, making it a less effective intervention compared to positioning the client on their side.

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