Nursing Elites

1. 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.

2. The nurse is caring for a client who is receiving chemotherapy. Which laboratory result indicates that the client is at risk for infection?

• A. Hemoglobin level of 12 g/dL.
• B. Platelet count of 150,000/mm3.
• C. White blood cell count of 2,000/mm3.
• D. Serum creatinine level of 1.0 mg/dL.

Correct answer: C

Rationale: A white blood cell count of 2,000/mm3 is low and indicates leukopenia, which increases the client's risk for infection. Hemoglobin level and platelet count are not directly indicative of infection risk. Serum creatinine level is related to kidney function, not infection risk.

3. A healthcare professional is participating in the emergency care of a client who has just developed variceal bleeding. What intervention should the healthcare professional anticipate?

• A. Infusion of intravenous heparin
• B. IV administration of albumin
• C. STAT administration of vitamin K by the intramuscular route
• D. IV administration of octreotide

Correct answer: D

Rationale: The correct intervention for variceal bleeding is IV administration of octreotide. Octreotide helps control bleeding from varices by reducing portal blood flow and pressure, which is crucial in managing this emergency situation.

4. A client with portal hypertension who has developed ascites is scheduled for a paracentesis. What pre-procedure nursing intervention is essential?

• A. Encourage the client to empty the bladder
• B. Administer a laxative to clear the bowels
• C. Restrict the client's fluid intake
• D. Place the client in a supine position

Correct answer: A

Rationale: Emptying the bladder before a paracentesis is essential to prevent bladder injury during the procedure. A full bladder may be in the path of the needle insertion, increasing the risk of bladder puncture. Encouraging the client to empty the bladder ensures their safety and reduces the likelihood of complications.

5. For a patient with asthma, what is the primary purpose of prescribing salmeterol?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Suppress cough
• D. Thin respiratory secretions

Correct answer: B

Rationale: Salmeterol is classified as a long-acting beta2-agonist, which is used to prevent asthma attacks by providing extended bronchodilation. It is not typically used for immediate relief of acute bronchospasm or for suppressing cough. Additionally, salmeterol does not have the primary purpose of thinning respiratory secretions.

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