Nursing Elites

1. A nurse in a provider’s office is interviewing a client who is requesting an oral contraceptive. Which of the following findings in the client’s history is a contraindication to the use of combination oral contraceptives?

• A. Thyroid disease
• B. Allergy to penicillin
• C. Impaired liver function
• D. Abnormal blood glucose

Correct answer: C

Rationale: Impaired liver function is a contraindication to combination oral contraceptives. The liver metabolizes hormones, and any impairment can affect the metabolism of hormones, potentially leading to imbalances or toxicity. Thyroid disease, allergy to penicillin, and abnormal blood glucose levels are not contraindications to combination oral contraceptives.

2. A nurse is planning care for a client who has Alzheimer's disease and demonstrates confusion and wandering behavior. Which of the following should the nurse include in the plan of care?

• A. Place the client in seclusion when she is confused
• B. Request a prescription for PRN restraints when the client is wandering
• C. Dim the lighting in the client’s room
• D. Leave one side rail up on the client's bed

Correct answer: D

Rationale: The correct answer is to leave one side rail up on the client's bed. This action can help prevent falls while allowing the client to get up safely when needed, reducing the risk of injury from wandering. Placing the client in seclusion (Choice A) is not appropriate as it can lead to increased agitation and distress. Requesting restraints (Choice B) should be avoided as it can increase the risk of injuries and is not recommended for clients with Alzheimer's. Dimming the lighting (Choice C) may increase confusion and disorientation in clients with Alzheimer's disease.

3. A nurse in a mental health facility receives a change-of-shift report on four clients. Which of the following clients should the nurse assess first?

• A. Client placed in restraints for aggressive behavior
• B. A new client with a history of a 4.5 kg weight loss in the past two months
• C. Client who received a PRN dose of haloperidol 2 hours ago for increased anxiety
• D. Client who will be receiving his first ECT treatment today

Correct answer: A

Rationale: A client in restraints due to aggressive behavior needs immediate assessment to ensure safety and well-being. The nurse should assess this client first to address any potential risks, such as circulation issues, skin integrity problems, and ongoing agitation. Choices B, C, and D do not present immediate safety concerns that require urgent assessment compared to a client restrained for aggressive behavior.

4. A client is being educated about using an intrauterine device (IUD) for contraception. Which of the following client statements indicate an understanding of the teaching?

• A. I will need to have the IUD replaced each year.
• B. I will need to apply a spermicide prior to intercourse.
• C. I should expect my periods to stop while I have the IUD.
• D. I should check for the string each month after menstruation.

Correct answer: D

Rationale: The correct answer is D because the client should check for the string each month after menstruation to ensure the IUD is in place. This practice helps in identifying any displacement of the IUD. Choices A, B, and C are incorrect. A is incorrect because IUDs have different durations depending on the type, not all require yearly replacement. B is incorrect because IUDs do not require spermicide for effectiveness. C is incorrect because while some individuals may experience changes in their menstrual patterns, it is not guaranteed that periods will stop while using an IUD.

5. A nurse is caring for a client who has been experiencing repeated tonic-clonic seizures over the course of 30 min. After maintaining the client’s airway and turning the client on their side, which of the following medications should the nurse administer?

• A. Diazepam IV
• B. Lorazepam PO
• C. Diltiazem IV
• D. Clonazepam PO

Correct answer: A

Rationale: In the scenario of a client experiencing prolonged seizures, such as status epilepticus, the priority is to administer a benzodiazepine to stop the seizure activity. Diazepam is the medication of choice for this situation due to its rapid onset of action and effectiveness in terminating seizures quickly. Lorazepam, although another benzodiazepine, is typically given through routes other than oral (PO) administration in emergency situations. Diltiazem is a calcium channel blocker used for cardiac conditions, not for seizure management. Clonazepam is a benzodiazepine, but it is usually not the first choice in the acute management of status epilepticus.

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