Nursing Elites

1. A laboring client received meperidine IV one hour prior to delivery. Which of the following medications should the nurse have available to counteract the effects of this medication on the newborn?

• A. Naloxone
• B. Epinephrine
• C. Atropine
• D. Diazepam

Correct answer: A

Rationale: Meperidine is an opioid analgesic that can cross the placenta and cause respiratory depression in the newborn. Naloxone is an opioid antagonist that is administered to reverse the effects of opioids. It is critical to have Naloxone available when opioids are administered during labor, especially close to delivery. Epinephrine is not used to counteract the effects of opioids but rather for managing severe allergic reactions or cardiac arrest. Atropine is used for specific conditions like bradycardia, not to counteract opioid effects. Diazepam is a benzodiazepine used for anxiety, seizures, and muscle spasms, not for reversing opioid effects.

2. What is the first action when a client who is admitted with schizophrenia reports hearing voices telling them to harm themselves?

• A. Administer antipsychotic medication
• B. Ask the client what the voices are saying
• C. Distract the client with another activity
• D. Call the healthcare provider

Correct answer: B

Rationale: The correct first action when a client with schizophrenia reports hearing voices telling them to harm themselves is to ask the client what the voices are saying. This is important to assess the content of the hallucinations and determine if there is any immediate danger or suicidal intent. Administering antipsychotic medication without knowing the content of the voices or the level of danger could be inappropriate and potentially harmful. Distracting the client with another activity may not address the underlying issue of the hallucinations commanding harm. Calling the healthcare provider can be done after assessing the situation and gathering information from the client.

3. A nurse on a postpartum unit is receiving change-of-shift report for four clients. Which of the following clients should the nurse see first?

• A. A client who gave birth 1 day ago and needs Rho(D) immune globulin
• B. A client who gave birth 3 days ago and reports breast fullness
• C. A client who gave birth 12 hours ago and reports an increase in urinary output
• D. A client who gave birth 8 hours ago and is saturating a perineal pad every hour

Correct answer: D

Rationale: The nurse should see the client saturating a perineal pad every hour first. This client may be experiencing postpartum hemorrhage, which is a medical emergency requiring immediate assessment and intervention. The other options describe clients with less urgent needs. The client needing Rho(D) immune globulin can wait, the breast fullness in the client who gave birth 3 days ago can be addressed after managing the postpartum hemorrhage, and an increase in urinary output in a client who gave birth 12 hours ago is not indicative of an immediate emergency like postpartum hemorrhage.

4. A nurse is caring for a client who has an indwelling urinary catheter. What should the nurse identify as a catheter occlusion?

• A. Pain during urination
• B. Bladder distention
• C. Cloudy urine
• D. Blood in the catheter tube

Correct answer: B

Rationale: The correct answer is B: Bladder distention. Bladder distention indicates that the bladder is full and there is impaired elimination, which could be caused by catheter occlusion. Pain during urination (choice A) is not typically associated with catheter occlusion but may indicate a urinary tract infection. Cloudy urine (choice C) can be a sign of infection but is not specific to catheter occlusion. Blood in the catheter tube (choice D) may indicate trauma during catheter insertion but is not a typical finding in catheter occlusion.

5. A client with a permanent spinal cord injury is scheduled for discharge. Which of the following client statements indicates that the client is coping effectively?

• A. “I would like to play wheelchair basketball. When I get stronger, I think I’ll look for a league.”
• B. “I’m glad I’ll only be in this wheelchair temporarily. I can’t wait to get back to running.”
• C. “I’m so upset that this happened to me. What did I do to deserve this, and why am I not getting better?”
• D. “I feel like I’ll never be able to do anything that I want to again. All I am is a burden to my family.”

Correct answer: A

Rationale: Choice A is the correct answer. This statement demonstrates effective coping as the client is showing acceptance of their disability and planning for the future with realistic goals. Choice B reflects denial of the permanent disability by stating that they will only be in a wheelchair temporarily. Choice C shows distress and a lack of acceptance by questioning why the injury happened and why they are not improving. Choice D indicates feelings of hopelessness and being a burden, which are not signs of effective coping.

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