Nursing Elites

1. 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.

2. A nurse is caring for four clients. Which client should the nurse assess first?

• A. A client scheduled to receive chemotherapy for the first time
• B. A client post-appendectomy with diminished bowel sounds
• C. A client with hypothyroidism who is stuporous
• D. A client with burns requiring a sterile dressing change

Correct answer: C

Rationale: The correct answer is C. The client with hypothyroidism who is stuporous should be assessed first as this may indicate a critical condition, possibly related to severe hypothyroidism. Stupor is a state of near-unconsciousness or insensibility, suggesting a decline in neurological function that requires immediate evaluation. Choices A, B, and D do not present with immediate life-threatening conditions that require urgent assessment. While chemotherapy, post-appendectomy complications, and burn care are important, they do not pose the same level of immediate risk as a stuporous client.

3. A nurse in a provider's office is assessing the motor skill development of a 15-month-old toddler during a well-child visit. What gross motor skills should the nurse expect to observe?

• A. Walks without assistance using a wide stance
• B. Climbs stairs with assistance
• C. Runs smoothly
• D. Kicks a ball forward

Correct answer: A

Rationale: The correct answer is A. At 15 months, toddlers typically walk independently but may do so with a wide stance for balance. Choice B, climbing stairs with assistance, is more common around 18 months. Choice C, running smoothly, is usually achieved around 2 years of age. Choice D, kicking a ball forward, generally develops around 2 to 3 years of age. Therefore, for a 15-month-old toddler, the nurse should expect the child to walk without assistance using a wide stance for balance.

4. While caring for a client receiving oxytocin for labor augmentation, the nurse notes contractions occurring every 45 seconds and lasting 90 seconds. What should the nurse do?

• A. Discontinue the oxytocin infusion
• B. Increase the oxytocin infusion
• C. Apply an internal fetal monitor
• D. Administer an analgesic

Correct answer: A

Rationale: The correct action for the nurse to take in this situation is to discontinue the oxytocin infusion. The client is experiencing uterine hyperstimulation, which can lead to fetal distress and complications. By stopping the oxytocin, the nurse can help regulate contractions and prevent harm to the fetus. Increasing the oxytocin infusion would exacerbate the issue by further intensifying contractions. Applying an internal fetal monitor may be necessary for closer monitoring but is not the immediate action required. Administering an analgesic is not appropriate in this scenario as the primary concern is addressing the uterine hyperstimulation caused by oxytocin.

5. A nurse is providing discharge teaching for a client newly prescribed methadone. Which statement indicates a need for further teaching?

• A. I understand methadone slows my breathing.
• B. I understand methadone may cause me to have trouble sleeping.
• C. I will avoid alcohol while taking this medication.
• D. I’ll change positions slowly to prevent dizziness.

Correct answer: B

Rationale: The correct answer is B. Trouble sleeping is not a typical side effect of methadone; the nurse should clarify this misunderstanding. Choices A, C, and D are all correct statements regarding methadone. Methadone can indeed slow breathing, so it is important for the client to be aware of this effect. Avoiding alcohol while taking methadone is crucial due to the increased risk of central nervous system depression when alcohol is combined with methadone. Additionally, changing positions slowly can help prevent dizziness, which can be a side effect of methadone.

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