Nursing Elites

1. A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that:

• A. the client's body has developed tolerance, requiring more drug to produce the same effect
• B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence
• C. addiction involves psychological behaviors related to substance use, not just physical dependence
• D. the client is coping with chronic back pain and requires adjustments in the medication regimen

Correct answer: A

Rationale: When a client requires an increased dose of a drug, such as in this case with hydrocodone, it suggests that the body has developed tolerance to the medication. Tolerance means that the client needs more of the drug to achieve the same effect as before. This does not inherently indicate addiction, which involves psychological behaviors related to substance use. Choice B describes drug dependence, where the client is preoccupied with obtaining the drug and experiences loss of control, which is not the same as tolerance. Choice C correctly points out that addiction is more than just physical dependence with withdrawal symptoms and tolerance; it includes psychological factors. Choice D is irrelevant as it discusses adjusting the medication for pain management, not addressing the client's concern about addiction.

2. In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client's:

• A. feelings about what has been described
• B. thoughts about what has been described
• C. possible solutions to the problem
• D. intent in sharing the description

Correct answer: B

Rationale: In a psychosocial assessment, the nurse should progress from having the client describe problematic behaviors to eliciting their thoughts about the dilemmas. This step provides essential assessment data and insights into the client's interpretation of the situation. Asking about feelings, solutions, or intent in sharing the description is premature at this stage. Understanding the client's thoughts is crucial before delving into more complex emotional or problem-solving aspects. Therefore, the correct answer is to elicit the client's thoughts about the described behaviors and situations, as this helps the nurse gain a deeper understanding of the client's perspective and thought processes.

3. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:

• A. cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.
• B. have few, if any, side effects.
• C. are used to treat multiple types of cancer.
• D. are cell-cycle-specific agents.

Correct answer: A

Rationale: Alkylating agents, such as nitrogen mustards, are effective chemotherapeutic agents because they cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. This cross-linking interferes with DNA replication and transcription, leading to cell death. Choice B is incorrect because alkylating agents have numerous side effects, including alopecia, nausea, vomiting, and myelosuppression. Choice C is incorrect because while nitrogen mustards are used to treat multiple types of cancer like chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and breast and ovarian cancer, their effectiveness is primarily due to DNA cross-linkage. Choice D is incorrect because alkylating agents are non-cell-cycle-specific agents, meaning they can act on cells in any phase of the cell cycle, not just on cells that are actively dividing.

4. The nurse is assigned to care for an infant with physiologic jaundice. Which action by the nurse would facilitate elimination of the bilirubin?

• A. Increasing the infant's fluid intake
• B. Maintaining the infant's body temperature at 98.6�F
• C. Minimizing tactile stimulation
• D. Decreasing caloric intake

Correct answer: A

Rationale: Bilirubin is excreted through the kidneys, therefore increasing fluid intake can help facilitate its elimination. Maintaining the infant's body temperature is important for overall health but does not directly assist in eliminating bilirubin, making choice B incorrect. Choices C and D are irrelevant to bilirubin elimination in this scenario and do not address the specific issue of physiologic jaundice.

5. The licensed practical nurse assigned to the postpartum unit is preparing to administer Rhogam to a postpartum client. Which woman is not a candidate for RhoGam?

• A. A gravida IV para 3 that is Rh negative with an Rh-positive baby
• B. A gravida I para 1 that is Rh negative with an Rh-positive baby
• C. A gravida II para 0 that is Rh negative admitted after a stillbirth delivery
• D. A gravida IV para 2 that is Rh negative with an Rh-negative baby

Correct answer: D

Rationale: The mothers in answers A, B, and C all require RhoGam as they are Rh negative with an Rh-positive baby or have experienced a stillbirth delivery, making them candidates for RhoGam injection. The mother in answer D is the only one who does not require Rhogam because she is Rh negative with an Rh-negative baby, eliminating the need for RhoGam administration.

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