Nursing Elites

1. A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?

• A. Withhold the benzodiazepine but continue the opioid
• B. Contact the provider about replacing the opioid with an NSAID
• C. Administer the benzodiazepine but withhold the opioid
• D. Continue the medication dosages that relieve the client's pain

Correct answer: B

Rationale: The correct action for the nurse to take is to contact the provider about replacing the opioid with an NSAID. In this scenario, the client is experiencing excessive sedation after the administration of both opioid and benzodiazepine. Switching to a non-opioid analgesic like an NSAID can help manage pain effectively without causing additional sedation. Option A is incorrect because continuing the opioid may exacerbate sedation. Option C is incorrect as administering the benzodiazepine may further increase sedation. Option D is incorrect because maintaining the current medication dosages that are causing excessive sedation is not in the client's best interest.

2. Select the criteria that is accurately paired with its indication of birth weight or gestational age.

• A. Low birth weight: The neonate's weight is less than 1,500 g at the time of delivery.
• B. Appropriate for gestational age: The neonate's weight ranges from the 10th to the 90th percentile.
• C. Large for gestational age: The neonate's weight is above the 99th percentile.
• D. Small for gestational age: The neonate's weight is below the 20th percentile.

Correct answer: B

Rationale: Appropriate for gestational age (AGA) indicates a neonate's weight ranging from the 10th to the 90th percentile. This range signifies that the baby's weight is within the normal range for their gestational age. Choices A, C, and D provide inaccurate information about the criteria and do not correctly correspond to the indicated birth weight or gestational age. Low birth weight typically refers to a weight below 2,500 g, large for gestational age above the 90th percentile, and small for gestational age below the 10th percentile.

3. What is the primary goal of public health?

• A. To focus on individual patient care
• B. To improve the health of populations
• C. To reduce healthcare costs
• D. To increase hospital admissions

Correct answer: B

Rationale: The primary goal of public health is to improve the health of populations by focusing on prevention, health promotion, and addressing the social determinants of health. Choice A is incorrect because public health looks at health from a population perspective rather than focusing on individual patient care. Choice C, while a potential benefit, is not the primary goal of public health. Choice D is incorrect as increasing hospital admissions is not a goal of public health; in fact, public health aims to prevent unnecessary hospitalizations through preventive measures.

4. Select the tactile sensation that is accurately paired with its description or procedure for testing.

• A. Fine motor coordination: The use of the fingers
• B. Stereognosis: Equal hearing in both ears
• C. Two-point discrimination: The nurse gently pricks the patient's skin
• D. Gross motor function: The use of the lower limbs

Correct answer: C

Rationale: The correct answer is C: Two-point discrimination: The nurse gently pricks the patient's skin. Two-point discrimination assesses the ability to discern two points touched simultaneously on the skin. Fine motor coordination (Choice A) refers to the precise movements of small muscles, not related to tactile sensation. Stereognosis (Choice B) is the ability to recognize objects by touch, not equal hearing in both ears. Gross motor function (Choice D) involves the coordination of large muscle groups, not specifically related to tactile sensation testing.

5. The wound irrigation process cleanses the wound and:

• A. Reduces the potential pain in the wound region or area.
• B. Stops the spread of infection by creating a 'clean' area.
• C. Pushes extravasated blood from a hematoma into nearby healthy tissue.
• D. Allows for the introduction of medications in solution form.

Correct answer: D

Rationale: The correct answer is D because wound irrigation allows for the introduction of medications in solution form to the wound site. Choice A is incorrect because while wound irrigation can help with pain management indirectly by promoting healing, its primary purpose is not to reduce pain directly. Choice B is incorrect as wound irrigation primarily aims to cleanse the wound and remove contaminants rather than creating a 'clean' area to stop infection spread. Choice C is incorrect because wound irrigation does not involve pushing extravasated blood from a hematoma into nearby healthy tissue; its main goal is to cleanse the wound and promote healing.

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