Nursing Elites

1. A healthcare provider is reviewing the medical record of a client who has schizophrenia and is taking clozapine. Which finding should the healthcare provider identify as a contraindication to the administration of clozapine?

• A. Heart rate 58/min.
• B. Fasting blood glucose 100 mg/dL.
• C. Hgb 14 g/dL.
• D. WBC count 2,900/mm3.

Correct answer: D

Rationale: The correct answer is D: a low WBC count. Clozapine can suppress bone marrow function, leading to a decreased white blood cell count. This condition, known as agranulocytosis, increases the risk of severe infections. Monitoring WBC counts is essential during clozapine therapy. Choices A, B, and C are within normal ranges and are not contraindications for administering clozapine.

2. A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

• A. Arrange for an ethics committee meeting to address the family's concerns
• B. Support the family's decision and initiate life-sustaining measures
• C. Complete an incident report
• D. Encourage the family to contact an attorney

Correct answer: A

Rationale: In this scenario, the nurse should arrange for an ethics committee meeting to address the family's concerns while ensuring the client's wishes are respected. Choosing option A allows for a formal discussion involving healthcare professionals, family members, and possibly a legal expert to navigate the situation ethically and legally. Supporting the family's decision to initiate life-sustaining measures (option B) would disregard the client's advance directives and autonomy. Completing an incident report (option C) is not appropriate in this situation as it does not address the conflict of interest between the family's desires and the client's wishes. Encouraging the family to contact an attorney (option D) may escalate the situation unnecessarily before exploring more ethical and collaborative approaches.

3. A client is at risk for developing deep vein thrombosis (DVT). Which of the following actions should the nurse take?

• A. Encourage the client to remain on bed rest.
• B. Massage the client's legs every 4 hours.
• C. Apply sequential compression devices to the client's legs.
• D. Administer anticoagulants as prescribed.

Correct answer: C

Rationale: The correct action the nurse should take for a client at risk for developing DVT is to apply sequential compression devices to the client's legs. This intervention helps prevent venous stasis by promoting circulation and reducing the risk of DVT. Encouraging the client to remain on bed rest (Choice A) can actually increase the risk of DVT due to immobility. Massaging the client's legs every 4 hours (Choice B) can dislodge blood clots and is contraindicated in DVT prevention. While administering anticoagulants as prescribed (Choice D) is a treatment for DVT, it is not a preventive measure for a client at risk.

4. A nurse is caring for a client who has diaper dermatitis. Which of the following actions should the nurse take?

• A. Apply zinc oxide ointment to the irritated area
• B. Wipe stool from the skin using store-bought baby wipes
• C. Apply talcum powder to the irritated area
• D. Apply a warm compress to the irritated area

Correct answer: A

Rationale: Correct answer: Applying zinc oxide ointment to the irritated area is the most appropriate action for diaper dermatitis. Zinc oxide is a barrier cream that helps protect the skin and promote healing. Choice B is incorrect because using store-bought baby wipes may contain chemicals or fragrances that can further irritate the skin. Choice C is incorrect as talcum powder can also worsen the condition by drying out the skin. Choice D is incorrect because a warm compress is not typically used for diaper dermatitis; it may provide relief for other conditions but is not the best option for diaper dermatitis.

5. A client who has a new prescription for lithium is receiving discharge teaching from a nurse. Which of the following client statements indicates an understanding of the teaching?

• A. I will need to have my blood levels checked regularly while taking this medication.
• B. I should take this medication on an empty stomach.
• C. I should avoid eating foods that are high in sodium.
• D. I should stop taking this medication if I experience nausea.

Correct answer: A

Rationale: The correct answer is A. Clients prescribed lithium need regular monitoring of blood levels to ensure the medication's effectiveness and safety. This monitoring helps to keep the medication within the therapeutic range and prevent toxicity. Choice B is incorrect because lithium is usually taken with food to minimize gastrointestinal side effects. Choice C is not directly related to lithium therapy; however, excessive sodium intake can affect lithium levels. Choice D is incorrect as abruptly stopping lithium can lead to adverse effects and should only be done under healthcare provider guidance.

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