Nursing Elites

1. A female client with breast cancer who completed her first chemotherapy treatment today at an outpatient center is preparing for discharge. Which behavior indicates that the client understands her care needs?

• A. Rented movies and borrowed books to use while passing time at home
• B. Discussing dietary restrictions with the nurse
• C. Arranging follow-up appointments with her oncologist
• D. Reporting to the nurse any new or worsening symptoms

Correct answer: D

Rationale: The correct answer is D because reporting any new or worsening symptoms to the nurse is crucial for the early detection of potential complications. This behavior shows that the client understands the importance of monitoring her health status post-chemotherapy treatment. Choices A, B, and C are incorrect because while renting movies, borrowing books, discussing dietary restrictions, and arranging follow-up appointments are all important aspects of care, the most critical factor immediately after chemotherapy is to monitor and report any new or worsening symptoms to healthcare providers.

2. The nurse is assessing an older adult with type 2 diabetes. Which assessment finding indicates that the client understands long-term control of diabetes?

• A. The fasting blood sugar was 120 mg/dL this morning
• B. Urine ketones have been negative for the past 6 months
• C. The hemoglobin A1C was 6.5% last week
• D. No diabetic ketoacidosis has occurred in 6 months

Correct answer: C

Rationale: An A1C level of 6.5% indicates good long-term control of diabetes as it reflects the average blood sugar levels over the past 2-3 months. Monitoring fasting blood sugar provides immediate information about the current blood sugar level, while the absence of urine ketones indicates short-term control. Although the absence of diabetic ketoacidosis is positive, it doesn't specifically reflect long-term control like the A1C level does.

3. What information is most important for the nurse to provide to an adolescent female prescribed azithromycin for lower lobe pneumonia and recurrent chlamydia?

• A. Ensure the partner is screened for chlamydia
• B. Report any signs of liver dysfunction immediately
• C. Avoid consuming grapefruit juice while on this medication
• D. Use two forms of contraception while taking this drug

Correct answer: D

Rationale: The most important information for the nurse to provide to an adolescent female prescribed azithromycin for lower lobe pneumonia and recurrent chlamydia is to use two forms of contraception while taking this drug. Azithromycin can reduce the effectiveness of hormonal contraceptives, increasing the risk of pregnancy. It is crucial to convey this information to prevent unintended pregnancies. Option A is incorrect as the partner should be screened for chlamydia, not HIV, in this case. Option B is not the most important information to provide as liver dysfunction is a rare side effect of azithromycin. Option C is irrelevant as grapefruit juice does not interact with azithromycin. Therefore, the priority information to convey is the importance of using dual contraception to prevent pregnancy.

4. The nursing staff on a medical unit includes a registered nurse (RN), practical nurse (PN), and an unlicensed assistive personnel (UAP). Which task should the charge nurse assign to the RN?

• A. Transport a client who is receiving IV fluid to the radiology department
• B. Administer PRN oral analgesics to a client with a history of chronic pain
• C. Supervise a newly hired graduate nurse during an admission assessment
• D. Complete ongoing focused assessments of a client with wrist restraints

Correct answer: C

Rationale: The correct answer is C because supervising a newly hired graduate nurse during an admission assessment is a task that falls within the registered nurse's scope of practice. Registered nurses are responsible for overseeing and delegating tasks, especially to new staff, to ensure proper assessment and care delivery. Choices A, B, and D involve tasks that can be appropriately assigned to practical nurses or unlicensed assistive personnel as they are within their scope of practice. Transporting a client, administering oral analgesics, and completing focused assessments do not require the advanced knowledge and skills of a registered nurse.

5. When attempting to establish risk reduction strategies in a community, the nurse notes that regional studies indicate a high number of persons with growth stunting and irreversible mental deficiencies caused by hypothyroidism (cretinism). The nurse should seek funding to implement which screening measure?

• A. T3 levels in school-aged children
• B. T4 levels in newborns
• C. TSH levels in women over 45
• D. Iodine levels in all persons over 60

Correct answer: B

Rationale: Screening T4 levels in newborns is crucial as it helps in the early detection of hypothyroidism, which can prevent conditions like cretinism. Checking T3 levels in school-aged children (Choice A) is not the most appropriate measure for early detection of hypothyroidism in newborns. Monitoring TSH levels in women over 45 (Choice C) is not directly related to detecting hypothyroidism in newborns. Additionally, monitoring iodine levels in all persons over 60 (Choice D) is not specifically aimed at early detection of hypothyroidism in newborns, which is crucial to prevent cretinism.

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