Nursing Elites

1. A client with a 42-week gestation refuses induction. What is the most important action the nurse should take?

• A. Discuss alternative ways to support the client's birth plan.
• B. Explain the risks of induction after 42 weeks.
• C. Ask the healthcare provider to discuss the situation with the client.
• D. Discuss the characteristics of labor with oxytocin vs. natural labor.

Correct answer: A

Rationale: The most important action for the nurse in this situation is to discuss alternative ways to support the client's birth plan. By doing so, the nurse can ensure that the client feels heard, respected, and supported in their decision-making process. While explaining the risks of induction after 42 weeks (Choice B) may be important, it is secondary to supporting the client's autonomy and preferences. Asking the healthcare provider to discuss the situation with the client (Choice C) may delay crucial communication and support that the nurse can provide. Discussing the characteristics of labor with oxytocin vs. natural labor (Choice D) is not the priority when the client has refused induction, as the focus should be on respecting their decision and exploring other options for support.

2. A client has been given a prescription for tetracycline HCL (Sumycin). The nurse should emphasize the client to

• A. Take the medication with food or milk
• B. Avoid prolonged sun exposure
• C. Monitor for signs of yellowing skin or eyes
• D. Expect a yellow-brown discoloration of the teeth

Correct answer: C

Rationale: The correct answer is C: 'Monitor for signs of yellowing skin or eyes.' Tetracycline can cause hepatotoxicity, leading to jaundice which may present as yellowing of the skin or eyes. This is a serious side effect that the nurse should emphasize to the client. Choice A is incorrect because tetracycline should generally be taken on an empty stomach, not with food or milk. Choice B is also incorrect as tetracycline can cause photosensitivity, but it is not directly related to yellowing skin or eyes. Choice D is incorrect because tetracycline can cause yellow-brown discoloration of the teeth, but this is usually seen in children under 8 years of age, not a common concern for adult clients.

3. A client with heart failure reports nausea, vomiting, yellow vision, and palpitations. What should the nurse assess first?

• A. Administer antiemetics to reduce nausea.
• B. Obtain a list of the client's cardiac medications.
• C. Perform an ECG to evaluate heart function.
• D. Review the client's dietary intake for possible causes.

Correct answer: B

Rationale: The combination of nausea, vomiting, yellow vision, and palpitations in a heart failure patient is indicative of digoxin toxicity. The nurse should first obtain a list of the client's medications to verify if they are taking digoxin.

4. A client with peripheral artery disease reports leg cramps while walking. What intervention should the nurse recommend?

• A. Encourage the client to rest immediately when cramping occurs.
• B. Recommend that the client increase their intake of potassium-rich foods.
• C. Advise the client to take a short break, then continue walking.
• D. Recommend that the client avoid walking altogether to prevent cramps.

Correct answer: C

Rationale: For clients with peripheral artery disease, advising the client to take a short break when leg cramps occur and then continue walking is the appropriate intervention. This approach, known as interval walking, helps manage pain from intermittent claudication and improves circulation over time. Choice A is incorrect because immediate rest may not be necessary, and encouraging the client to resume walking after a short break is more beneficial. Choice B is incorrect since increasing potassium-rich foods may not directly address the underlying issue of peripheral artery disease causing cramps. Choice D is incorrect as avoiding walking altogether can lead to further deconditioning and worsen symptoms over time.

5. A client who had a vasectomy is in the post-recovery unit at an outpatient clinic. Which of these points is most important to be reinforced by the nurse?

• A. Until the healthcare provider has determined that your ejaculate doesn't contain sperm, continue to use another form of contraception.
• B. This procedure doesn't impede the production of male hormones or the production of sperm in the testicles. The sperm can no longer enter your semen, and no sperm are in your ejaculate.
• C. After your vasectomy, strenuous activity needs to be avoided for at least 48 hours. If your work doesn't involve hard physical labor, you can return to your job as soon as you feel up to it. The stitches generally dissolve in seven to ten days.
• D. The healthcare provider at this clinic recommends rest, ice, an athletic supporter, or over-the-counter pain medication to relieve any discomfort.

Correct answer: A

Rationale: The most important point to reinforce after a vasectomy is to continue using contraception until the healthcare provider confirms the absence of sperm in the ejaculate. Choice A is correct because it emphasizes the necessity of another form of contraception until sperm absence is confirmed. Choice B is incorrect because it focuses on how a vasectomy works anatomically rather than the need for ongoing contraception. Choice C is incorrect as it discusses post-vasectomy care but does not address the need for continued contraception. Choice D is also incorrect as it refers to general post-procedure recommendations but does not highlight the crucial aspect of using contraception until sperm absence is confirmed.

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