Nursing Elites

1. A charge nurse is teaching a newly licensed nurse about the care of a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which of the following statements should the charge nurse identify as an indication that the newly licensed nurse understands the teaching?

• A. I should obtain a specimen for culture and sensitivity after the first dose of an antimicrobial.
• B. MRSA is usually resistant to vancomycin, so another antimicrobial will be prescribed.
• C. I will protect others from exposure when I transport the client outside the room.
• D. To decrease resistance, antimicrobial therapy is discontinued when the client is no longer febrile.

Correct answer: C

Rationale: The correct answer is C. Protecting others from exposure when transporting a client with MRSA is crucial in preventing the spread of infection. This statement demonstrates understanding of infection control measures. Stating that MRSA is usually resistant to vancomycin (choice B) is incorrect; vancomycin is often effective against MRSA. Obtaining a specimen for culture and sensitivity after the first dose of an antimicrobial (choice A) is unnecessary and not indicated. Discontinuing antimicrobial therapy when the client is no longer febrile (choice D) is incorrect because antimicrobial therapy should be completed as prescribed to prevent the development of resistant strains.

2. A client who has a new prescription for warfarin (Coumadin) is receiving discharge instructions. Which statement indicates the client understands the teaching?

• A. I will take my warfarin at the same time every day.
• B. I should increase my intake of green leafy vegetables.
• C. I should use a soft-bristled toothbrush while taking this medication.
• D. I should avoid drinking alcohol while taking this medication.

Correct answer: C

Rationale: The correct answer is C: 'I should use a soft-bristled toothbrush while taking this medication.' Using a soft-bristled toothbrush is crucial as it helps prevent bleeding gums, which is a potential side effect of warfarin therapy. Option A about taking warfarin at the same time every day is a good practice but does not directly relate to preventing side effects. Option B suggesting an increase in green leafy vegetables can interfere with warfarin's anticoagulant effects due to their vitamin K content. Option D advising to avoid alcohol is generally recommended but is not directly related to the specific side effects of warfarin.

3. The nurse in the emergency department observes a colleague viewing the electronic health record (EHR) of a client who holds an elected position in the community. The client is not a part of the colleague's assignment. Which action should the nurse implement?

• A. Communicate the colleague's actions to the unit charge nurse
• B. Send an email to facility administration reporting the action
• C. Write an anonymous complaint to a professional website
• D. Post a comment about the action on a staff discussion board

Correct answer: A

Rationale: Communicating the colleague's actions to the unit charge nurse is the most appropriate action to take in this scenario. Reporting to the charge nurse follows proper protocol and ensures privacy compliance. This option allows for addressing the issue internally within the healthcare setting, maintaining confidentiality, and following the chain of command. Sending an email to facility administration (Choice B) might be premature without internal investigation and could potentially bypass the immediate supervisor who is responsible for addressing such issues. Writing an anonymous complaint to a professional website (Choice C) and posting a comment about the action on a staff discussion board (Choice D) are not professional or effective ways to address the situation, as they do not ensure proper handling of the breach of privacy within the organization.

4. The patient is receiving chemotherapy for breast cancer. Which of the following laboratory values would be most important to monitor?

• A. White blood cell count
• B. Hemoglobin level
• C. Serum creatinine
• D. Blood glucose level

Correct answer: A

Rationale: Monitoring the white blood cell count is crucial when a patient is undergoing chemotherapy for breast cancer. Chemotherapy can lead to neutropenia, a condition of low white blood cell count, which significantly increases the risk of infections. Monitoring white blood cell count helps healthcare providers intervene promptly to prevent severe infections. Hemoglobin level, while important in assessing oxygen-carrying capacity, is not the priority in this scenario. Serum creatinine and blood glucose levels are not directly impacted by chemotherapy for breast cancer.

5. A healthcare provider is providing teaching about health promotion guidelines to a group of young adult male clients. Which of the following guidelines should the healthcare provider include?

• A. Obtain a tetanus booster every 5 years.
• B. Obtain a herpes zoster immunization by age 50.
• C. Have a dental examination every 6 months.
• D. Have a testicular examination every 2 years.

Correct answer: C

Rationale: Having a dental examination every 6 months is crucial for young adult males as it helps in maintaining good oral health and detecting any potential issues early on. Tetanus booster every 10 years is recommended for adults, not every 5 years (Choice A). Herpes zoster immunization is typically recommended for individuals aged 60 and older, not by age 50 (Choice B). While testicular self-examination is important for detecting testicular cancer, routine clinical testicular examinations are not generally needed every 2 years (Choice D). Therefore, the correct answer is to have a dental examination every 6 months.

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