Nursing Elites

1. A client with cancer is to undergo an intravenous pyelogram. The nurse should:

• A. Ensure adequate fluid intake 24 hours before the procedure
• B. Ask the client to void immediately before the study
• C. Administer medication that affects the central nervous system as prescribed
• D. Position the client appropriately for the procedure

Correct answer: B

Rationale: The correct answer is to ask the client to void immediately before the study. For an intravenous pyelogram, the client may have orders for laxatives or enemas, so ensuring the client voids before the test is important to prevent obscuring visualization of the kidney, ureters, and bladder. Choice A is incorrect because there is no need to force fluids before the procedure. Choice C is incorrect as medications affecting the central nervous system should not be held unless specified by the healthcare provider. Choice D is incorrect as covering the reproductive organs with an x-ray shield is not necessary for an intravenous pyelogram.

2. All of the following are common reasons that nurses are reluctant to delegate except:

• A. lack of self-confidence
• B. desire to maintain authority
• C. confidence in subordinate
• D. getting trapped in the 'I can do it better myself' mindset

Correct answer: C

Rationale: If a delegator has confidence in their subordinates and believes a task will be performed correctly, they are more likely to delegate. Reasons nurses may be reluctant to delegate include their own lack of self-confidence, the desire to maintain authority, and getting trapped in the 'I can do it better myself' mindset. Therefore, 'confidence in subordinate' is the exception as it actually encourages delegation. The other choices are common barriers to delegation in healthcare settings.

3. The client is taking prednisone 7.5mg po each morning to treat his systemic lupus erythematosus. Which statement best explains the reason for taking the prednisone in the morning?

• A. There is less chance of forgetting the medication if taken in the morning.
• B. There will be less fluid retention if taken in the morning.
• C. Prednisone is absorbed best with the breakfast meal.
• D. Morning administration mimics the body's natural secretion of corticosteroid.

Correct answer: D

Rationale: Taking corticosteroids in the morning mimics the body's natural release of cortisol, which follows a diurnal pattern with higher levels in the morning. This timing helps regulate the body's inflammatory response and minimizes potential side effects. Answer A is not the primary reason for morning dosing, as adherence concerns can be addressed through other means. Answer B is incorrect since fluid retention is not influenced by the timing of prednisone administration. Answer C is also incorrect as prednisone absorption is not significantly affected by whether it is taken with breakfast or not.

4. Six hours after birth, the infant is found to have an area of swelling over the right parietal area that does not cross the suture line. The nurse should chart this finding as:

• A. A cephalohematoma
• B. Molding
• C. Subdural hematoma
• D. Caput succedaneum

Correct answer: A

Rationale: The correct answer is A, a cephalohematoma. A cephalohematoma is an area of bleeding outside the cranium but beneath the periosteum, typically not crossing the suture line. Answer B, molding, is the overlapping of the bones of the cranium and does not involve bleeding, making it an incorrect choice. Answer C, a subdural hematoma, involves intracranial bleeding and is typically diagnosed through imaging studies like a CAT scan or x-ray. Answer D, caput succedaneum, is characterized by edema that crosses the suture line, unlike the described swelling in this case.

5. The client is scheduled for a pericentesis. Which instruction should be given to the client before the exam?

• A. "You will need to lie flat during the exam."?
• B. "You need to empty your bladder before the procedure."?
• C. "You will be asleep during the procedure."?
• D. "The doctor will inject a medication to treat your illness during the procedure."?

Correct answer: B

Rationale: The client scheduled for a pericentesis should be instructed to empty the bladder to prevent the risk of bladder puncture when the needle is inserted. A pericentesis involves removing fluid from the peritoneal cavity. The client is typically positioned sitting up or leaning over a table, making answer A incorrect. During a pericentesis, the client is usually awake, so answer C is incorrect. Medications are not commonly injected into the peritoneal cavity during this procedure, making answer D incorrect. However, it's important to note that the administration of medications during the procedure could vary based on specific circumstances.

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