Nursing Elites

1. A healthcare professional is teaching a client about the use of methotrexate. Which of the following should be included?

• A. It is a pain reliever
• B. Monitor for signs of infection
• C. It can be taken without food
• D. It is safe to use during pregnancy

Correct answer: B

Rationale: The correct answer is B: 'Monitor for signs of infection.' Methotrexate can suppress the immune system, making the client more susceptible to infections. Educating the client to monitor for signs of infection is crucial for early detection and management. Choice A is incorrect because methotrexate is not a pain reliever; it is commonly used to treat conditions like cancer, rheumatoid arthritis, and psoriasis. Choice C is incorrect because methotrexate is usually recommended to be taken with food to reduce gastrointestinal side effects. Choice D is incorrect because methotrexate is known to be harmful during pregnancy and should not be used by pregnant individuals as it can cause birth defects.

2. A nurse is assessing a client 1 hour after birth and notes a boggy uterus located 2 cm above the umbilicus. What should the nurse do first?

• A. Take vital signs
• B. Assess lochia
• C. Massage the fundus
• D. Give oxytocin IV bolus

Correct answer: C

Rationale: A boggy uterus located 2 cm above the umbilicus suggests uterine atony, which is a common cause of postpartum hemorrhage. The initial intervention in this situation is to massage the fundus. Fundal massage helps the uterus contract, promoting hemostasis and preventing excessive bleeding. Taking vital signs or assessing lochia are important actions but are secondary to addressing uterine atony. Administering oxytocin IV bolus is often done after fundal massage to further enhance uterine contractions.

3. A nurse is caring for a newborn in the nursery following a circumcision. The newborn's grandparent, who does not have an identification bracelet, requests to take the newborn to his mother's room. What action should the nurse take?

• A. Notify security.
• B. Respectfully deny the grandparent’s request.
• C. Contact the mother for verification.
• D. Escort the grandparent and newborn to the room.

Correct answer: B

Rationale: The correct action for the nurse to take is to respectfully deny the grandparent's request. In healthcare settings, strict security protocols are in place to ensure the safety of newborns. Only individuals with proper identification bracelets are allowed to transport newborns to prevent unauthorized individuals from taking them. Contacting the mother for verification would be time-consuming and may not be feasible immediately. Escorting the grandparent and newborn without proper identification would violate security protocols and compromise the newborn's safety. Notifying security should be done only if there is a threat or concern for safety, which is not the case in this scenario. Therefore, the best course of action is for the nurse to respectfully deny the grandparent's request to uphold the safety and security measures in place.

4. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. How many mL should the nurse administer per dose? (Round to the nearest tenth)

• A. 2.6 mL
• B. 2.2 mL
• C. 3.5 mL
• D. 5.0 mL

Correct answer: A

Rationale: The correct calculation is as follows: The toddler's weight in kg is 13 kg (28.6 lb / 2.2 lb/kg). The total daily dose is 260 mg (20 mg x 13 kg). Therefore, the dose per administration is 130 mg (260 mg / 2). Given the concentration of 250 mg/5 mL, the dose in mL is 2.6 mL (130 mg / (250 mg/5 mL)). Therefore, the nurse should administer 2.6 mL per dose. Choice B, 2.2 mL, is incorrect as it does not reflect the correct calculation. Choices C and D, 3.5 mL and 5.0 mL, are also incorrect and do not align with the accurate dosage calculation based on the given scenario.

5. A client is being taught how to use a diaphragm for contraception. Which of the following client statements indicate an understanding of the teaching?

• A. I will leave the diaphragm in place for at least 6 hours after intercourse.
• B. I will remove the diaphragm by catching the rim below the dome with my finger.
• C. I will not apply mineral oil on the diaphragm.
• D. I will place 2 teaspoons of spermicide on the inside of the diaphragm before inserting it.

Correct answer: D

Rationale: The correct answer is D. The client should place spermicide inside the diaphragm before insertion to enhance contraceptive effectiveness. It is recommended to leave the diaphragm in place for at least 6 hours after intercourse, but not more than 24 hours. Choice A is incorrect because the diaphragm should be left in place for at least 6 hours, not 4 hours. Choice B is incorrect as the diaphragm should be removed by hooking the rim below the dome, not above. Choice C is incorrect because mineral oil should not be used with the diaphragm as it can weaken the latex.

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