Nursing Elites

1. A client being treated for sickle cell disease has an order for pain medication. Morphine was ordered, but the nurse is having difficulty deciphering the dose. The nurse should ____.

• A. ask the attending physician to clarify the order, including the correct medication, dose, route, and frequency
• B. call the charge nurse to inform the attending physician and verify the order, including the correct medication, dose, route, and frequency
• C. call the attending physician to verbally verify the order, including the correct medication, dose, route, and frequency
• D. refrain from administering the medication until the charge nurse can assist in determining the correct dosage

Correct answer: C

Rationale: In this scenario, when a nurse encounters difficulties in deciphering an order, the appropriate action is to contact the attending physician directly to clarify and verify the medication, dose, route, and frequency. It is crucial for the nurse to have a clear understanding of the order before administering any medication to ensure patient safety and proper treatment. Option A is incorrect as it suggests asking the attending physician to clarify without specifying the urgency of the situation. Option B involves an unnecessary additional step by first contacting the charge nurse before reaching out to the attending physician, potentially delaying the clarification process. Option D is incorrect as it advises refraining from administering the medication, which may not be necessary if the correct dosage can be promptly verified by contacting the attending physician.

2. A child comes to the clinic with a skin rash. The maculopapular lesions are distributed around the mouth and have honey-colored drainage. The caregiver states that the rash is getting worse and seems to spread with the child's scratching. Which of the following advisory comments should be given?

• A. The history and presentation might indicate chickenpox, a highly contagious disease.
• B. The lesions might indicate a noncontagious infection that does not require isolation.
• C. The history and presentation might indicate an infectious illness called impetigo.
• D. The lesions are not contagious unless others have open wounds or lesions themselves.

Correct answer: C

Rationale: The scenario describes classic impetigo, characterized by maculopapular lesions with honey-colored drainage, typically caused by Staphylococcus aureus or Streptococcus pyogenes. Antibiotic therapy is usually indicated for impetigo. Chickenpox, a highly contagious disease, presents with a history of high fever followed by a vesicular rash, different from the described maculopapular lesions with honey-colored drainage. Choice A is incorrect as the presentation is not consistent with chickenpox. Choice B is incorrect because impetigo is contagious, especially through direct contact. Choice D is also incorrect as impetigo is a contagious skin infection regardless of others having open wounds or lesions.

3. Which of these should not be included when calculating a client's fluid intake?

• A. ice chips
• B. Jell-O�
• C. pudding
• D. IV fluid from an antibiotic piggyback

Correct answer: C

Rationale: Pudding is a semi-solid and does not contribute significantly to fluid intake as it does not melt at room temperature. Therefore, it should not be included in fluid intake calculations. On the other hand, ice chips, Jell-O�, and IV fluid from an antibiotic piggyback are all sources of fluid that can significantly contribute to a client's total fluid intake and should be considered when calculating it. Ice chips and Jell-O� provide hydration upon melting, while IV fluid directly adds to the fluid volume in the body.

4. Which of the following enzymes is indicative of pancreatitis?

• A. alkaline phosphatase
• B. acid phosphatase
• C. creatine phosphokinase
• D. amylase

Correct answer: D

Rationale: Amylase is elevated in conditions of pancreatic inflammation, such as pancreatitis. Pancreatitis is characterized by the inflammation of the pancreas, leading to the leakage of amylase into the bloodstream. Elevated levels of amylase are a key diagnostic marker for pancreatitis. Alkaline phosphatase is associated with liver and bone conditions, not pancreatitis. Acid phosphatase is more related to prostate health and is not specific to pancreatitis. Creatine phosphokinase is found in tissues like muscle and brain, and elevated levels are seen in conditions like muscle injury or heart attack, not pancreatitis.

5. Why is client and family communication and education concerning restraints essential?

• A. confuses both groups further
• B. helps with coping and stress levels
• C. encourages cooperation with the client and family
• D. puts the responsibility on the client and family, not the nurse

Correct answer: C

Rationale: Client and family communication and education concerning restraints are essential to encourage cooperation. When the client and family understand the purpose and expected benefits of restraints, they are more likely to cooperate. This understanding can help prevent well-meaning family members from releasing restraints due to confusion or lack of information. Therefore, choice C is correct. Choices A, B, and D are incorrect because confusing both groups further, helping with coping and stress levels, and shifting responsibility to the client and family are not the primary goals of communication and education concerning restraints.

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