Nursing Elites

1. A charge nurse is planning care for a group of patients on a med-surg unit. What task should the nurse delegate to an assistive personnel?

• A. Measure hourly urinary output for the postoperative patient.
• B. Administer medications to stable patients.
• C. Reinforce patient education.
• D. Initiate a care plan for a new patient.

Correct answer: A

Rationale: The correct answer is A because assistive personnel can be assigned to measure and document urinary output, a routine task within their scope of practice. Administering medications (choice B) requires a higher level of training and should be done by licensed nurses. Reinforcing patient education (choice C) involves providing information and ensuring patient understanding, which is typically done by licensed healthcare providers. Initiating a care plan (choice D) involves critical thinking and assessment skills, which are beyond the scope of practice for assistive personnel.

2. When educating a client about valproic acid, which instruction is essential?

• A. Monitor for rash
• B. Expect weight loss
• C. Consider it safe during pregnancy
• D. Purchase it over-the-counter

Correct answer: A

Rationale: The correct answer is to instruct the client to monitor for rash. Valproic acid can lead to severe skin rashes, and patients must be vigilant to report any rash promptly. Choice B is incorrect as valproic acid is more likely to cause weight gain. Choice C is incorrect because valproic acid is associated with birth defects and should be avoided during pregnancy. Choice D is incorrect as valproic acid is a prescription medication and not available over-the-counter.

3. A nurse is caring for a client prescribed clopidogrel. Which of the following should the nurse monitor?

• A. Liver function tests
• B. Blood pressure
• C. Potassium levels
• D. Respiratory rate

Correct answer: A

Rationale: Corrected Rationale: Clopidogrel is an antiplatelet medication, so the nurse should monitor for signs of bleeding and liver function tests due to potential liver effects. Monitoring liver function tests is essential to detect any adverse effects on the liver because clopidogrel can cause hepatotoxicity. While monitoring blood pressure, potassium levels, and respiratory rate are important in general patient care, they are not the priority assessments specifically related to clopidogrel use.

4. A client with diabetes is receiving education on foot care. Which of the following should be included in the teaching?

• A. Inspect feet daily for cuts and sores
• B. Soak feet in warm water daily
• C. Wear closed-toe shoes at all times
• D. Trim toenails straight across

Correct answer: A

Rationale: The correct answer is A: Inspect feet daily for cuts and sores. Clients with diabetes are at an increased risk of foot complications, so it is essential to check for any cuts, sores, or injuries daily to prevent infections and complications. Soaking feet in warm water daily (choice B) is not recommended as it can lead to skin breakdown. Wearing closed-toe shoes at all times (choice C) is not advisable as it can cause excessive pressure and friction. Trimming toenails straight across (choice D) is the correct method to prevent ingrown toenails, not trimming them in a rounded shape.

5. A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test. Which of the following statements should the nurse plan to make?

• A. You will not receive medication through an IV for this test.
• B. You should expect the test to take about 30 minutes.
• C. You do not need to eat or drink for 4 hours prior to the test.
• D. This test will help determine if your baby's lungs are mature.

Correct answer: B

Rationale: The correct statement for the nurse to make is choice B, 'You should expect the test to take about 30 minutes.' The nonstress test is used to assess fetal well-being by monitoring fetal heart rate in response to movements. Choice A is incorrect because medications are not typically administered during a nonstress test. Choice C is incorrect as there is no need for the client to fast before the test. Choice D is incorrect because determining fetal lung maturity is usually done through other tests, not the nonstress test.

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