Nursing Elites

1. A client is admitted with an epidural hematoma after a skateboarding accident. How should the nurse differentiate the vascular source of intracranial bleeding?

• A. Monitor for clear fluid leakage from the nose.
• B. Assess for rapid onset of decreased level of consciousness.
• C. Check for bruising around the head and neck.
• D. Assess for changes in pupil size and reactivity.

Correct answer: B

Rationale: An epidural hematoma is characterized by a rapid onset of symptoms, including decreased level of consciousness, due to arterial bleeding, which differentiates it from other types of intracranial hemorrhage. Monitoring for clear fluid leakage from the nose (choice A) is more indicative of a basilar skull fracture and cerebrospinal fluid leak. Checking for bruising around the head and neck (choice C) is more suggestive of soft tissue injuries or facial fractures. Assessing for changes in pupil size and reactivity (choice D) is essential in evaluating traumatic brain injuries, but it is not specific to differentiating the vascular source of intracranial bleeding in an epidural hematoma.

2. The client is being taught about precautions with Coumadin therapy. The client should be instructed to avoid which over-the-counter medication?

• A. Non-steroidal anti-inflammatory drugs
• B. Cough medicines containing guaifenesin
• C. Histamine blockers
• D. Laxatives containing magnesium salts

Correct answer: A

Rationale: The correct answer is A: Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs can increase the risk of bleeding in clients taking Coumadin, which is an anticoagulant medication. Avoiding NSAIDs helps prevent potentially dangerous interactions with Coumadin. Choices B, C, and D are incorrect. Cough medicines with guaifenesin, histamine blockers, and laxatives containing magnesium salts do not typically have significant interactions with Coumadin therapy. Therefore, they are not the over-the-counter medications that the client needs to avoid while on Coumadin.

3. A client with hypothyroidism is experiencing severe lethargy and cold intolerance. What action should the nurse take?

• A. Increase the dose of levothyroxine.
• B. Administer a PRN dose of antipyretic medication.
• C. Provide a warm blanket and increase the room temperature.
• D. Increase the client's fluid intake to avoid dehydration.

Correct answer: A

Rationale: The correct answer is to increase the dose of levothyroxine. In hypothyroidism, the body does not produce enough thyroid hormone, leading to symptoms like lethargy and cold intolerance. Increasing the dose of levothyroxine, which is a synthetic thyroid hormone replacement, helps correct the deficiency and alleviates the symptoms. Choice B, administering antipyretic medication, is incorrect as antipyretics are used to reduce fever, not treat hypothyroidism symptoms. Choice C, providing a warm blanket and increasing room temperature, may provide temporary comfort but does not address the underlying hormonal deficiency. Choice D, increasing fluid intake, is important for overall health but does not directly address the symptoms of hypothyroidism.

4. A child has a nosebleed (epistaxis) while playing soccer. In what position should the nurse place the child?

• A. Position the child lying flat and apply pressure to the bridge of the nose.
• B. Position the child sitting up and leaning forward.
• C. Have the child tilt the head back and pinch the nose.
• D. Position the child lying on their side and apply ice to the nose.

Correct answer: B

Rationale: The correct answer is to position the child sitting up and leaning forward. This position helps prevent blood from flowing down the throat, reducing the risk of choking or vomiting. Choice A is incorrect because lying flat can cause blood to flow down the throat. Choice C is wrong as tilting the head back may lead to blood entering the throat. Choice D is also incorrect as applying ice is not recommended for nosebleeds and lying on the side may not prevent blood from flowing down the throat.

5. A 60-year-old female client with a positive family history of ovarian cancer has developed an abdominal mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear results are negative. What information should the nurse include in the client’s teaching plan?

• A. Pap smear is sufficient to detect ovarian cancer
• B. Surgery is unnecessary based on negative Pap smear
• C. Further evaluation involving surgery may be needed
• D. No further tests are needed

Correct answer: C

Rationale: A negative Pap smear does not rule out ovarian cancer, which often requires more comprehensive evaluation, including imaging studies or surgery. The client should be informed that the Pap smear primarily detects cervical cancer, not ovarian cancer. Therefore, further evaluation involving imaging studies or surgery may be necessary to determine the presence of ovarian cancer. Choice A is incorrect because a Pap smear is not sufficient to detect ovarian cancer. Choice B is incorrect because surgery may be necessary for further evaluation if ovarian cancer is suspected. Choice D is incorrect because further tests are needed to confirm or rule out ovarian cancer.

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