Nursing Elites

1. A client in labor states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first?

• A. Administer oxygen via face mask.
• B. Notify the operating room team.
• C. Place the client in Trendelenburg.
• D. Administer a fluid bolus of 500 ml.

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to place the client in Trendelenburg position. This position helps alleviate pressure on the umbilical cord, preventing compression and ensuring continued blood flow to the fetus. Administering oxygen, notifying the operating room team, or administering a fluid bolus are not the initial priority actions in a cord prolapse situation.

2. The mother of a 9-month-old who was diagnosed with respiratory syncytial virus (RSV) yesterday calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother?

• A. The child can be around other children but should wear a mask at all times.
• B. The child will no longer be contagious, no need to take any further precautions.
• C. Make sure there are no children under the age of 6 months around the infected child.
• D. Do not expose other children. RSV is very contagious even without direct oral contact.

Correct answer: D

Rationale: The correct response is to advise the mother not to expose other children to the infected child. RSV is highly contagious, and transmission can occur even without direct oral contact. It is crucial to prevent the spread of the virus to protect other children from getting infected.

3. A client with hypothyroidism is prescribed levothyroxine (Synthroid). Which instruction should the nurse provide?

• A. Take the medication with a meal.
• B. Take the medication at bedtime.
• C. Take the medication on an empty stomach.
• D. Take the medication with an antacid.

Correct answer: C

Rationale: The correct instruction for a client prescribed levothyroxine (Synthroid) is to take the medication on an empty stomach. This ensures optimal absorption of levothyroxine. Taking it with a meal can interfere with absorption due to food interactions. Taking it at bedtime may lead to inconsistent absorption as it should be taken at the same time every day in the morning. Taking it with an antacid can reduce the absorption of levothyroxine, making it less effective.

4. A patient with rheumatoid arthritis is prescribed methotrexate. What is an important teaching point for the nurse to provide?

• A. Take folic acid supplements as prescribed.
• B. Avoid alcohol completely.
• C. Expect to see immediate results.
• D. Limit fluid intake to 1 liter per day.

Correct answer: A

Rationale: The correct teaching point for a patient prescribed methotrexate is to take folic acid supplements as prescribed. Methotrexate can lead to a folate deficiency, which is why supplementing with folic acid is essential to reduce the risk of side effects such as mouth sores, nausea, and liver problems.

5. A client with chronic pain is prescribed a fentanyl (Duragesic) patch. Which instruction should the nurse provide to the client?

• A. Apply the patch to a clean, dry, and hairless area of the skin.
• B. Use a heating pad over the patch to enhance absorption.
• C. Change the patch daily to maintain effectiveness.
• D. Place the patch on the same site with each application.

Correct answer: A

Rationale: The correct instruction for applying a fentanyl (Duragesic) patch is to place it on a clean, dry, and hairless area of the skin. This ensures proper adhesion of the patch and optimal absorption of the medication. Using a heating pad over the patch is contraindicated as it can increase drug absorption and lead to overdose. Changing the patch daily is necessary for some medications, but fentanyl patches are usually changed every 72 hours to maintain a steady blood level of the medication. Placing the patch on the same site with each application can lead to skin irritation, uneven drug absorption, and should be avoided to allow the skin to recover between applications.

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