Nursing Elites

1. A client states, 'I can leave the diaphragm in place as long as I want after intercourse.' Which statement indicates to the nurse that the client needs further information on how to use the diaphragm?

• A. 'I need to reapply spermicidal cream with repeated intercourse.'
• B. 'The diaphragm needs to be filled with spermicidal cream before insertion.'
• C. 'I can leave the diaphragm in place as long as I want after intercourse.'
• D. 'The diaphragm can be inserted as long as 6 hours before intercourse.'

Correct answer: C

Rationale: The correct answer is the statement, 'I can leave the diaphragm in place as long as I want after intercourse.' This statement indicates a lack of understanding about the correct use of the diaphragm. The diaphragm must be left in place for at least 6 hours after intercourse to ensure effectiveness and reduce the risk of pregnancy. Leaving the diaphragm in place for an extended period can lead to toxic shock syndrome. Choice A is correct as spermicidal cream needs to be reapplied before each act of intercourse for optimal contraceptive efficacy. Choice B is a correct statement as the diaphragm should be filled with spermicidal cream before insertion to increase its effectiveness. Choice D is also accurate as the diaphragm can be inserted up to 6 hours before intercourse to allow time for proper placement and effectiveness.

2. When assessing a client with amyotrophic lateral sclerosis (ALS), the nurse should expect which of the following findings?

• A. mental confusion
• B. muscular weakness
• C. sensory loss
• D. emotional liability

Correct answer: B

Rationale: Clients with ALS typically present with progressive muscular weakness and wasting as a hallmark feature of the disease. This weakness affects voluntary muscles, leading to challenges in mobility and daily activities. Sensory loss is not a characteristic feature of ALS, and individuals usually maintain their mental clarity without experiencing mental confusion. Emotional liability, characterized by sudden, uncontrolled changes in emotions, is not a common finding in ALS. While individuals may experience periods of grief due to the progressive nature of the disease, emotional liability is not a usual manifestation. Therefore, the correct finding to expect when assessing a client with ALS is muscular weakness.

3. Which NSAID is comparable to morphine in efficacy?

• A. Feldene
• B. Stodal
• C. Toradol
• D. Elavil

Correct answer: C

Rationale: The correct answer is Toradol. Toradol is the first injectable NSAID that has been found to be comparable to morphine in terms of efficacy. Feldene (choice A) is not known for being comparable to morphine in efficacy. Stodal (choice B) is a homeopathic cough syrup and not an NSAID. Elavil (choice D) is a tricyclic antidepressant and not an NSAID, so it is not comparable to morphine in efficacy. Therefore, Toradol is the most appropriate choice as it matches the description provided in the question.

4. An LPN is having a conflict with another nurse during her shift. She has tried to discuss the issues with the nurse with no resolution. What is the most appropriate way for the LPN to proceed?

• A. Report the conflict to the director of nursing over the unit.
• B. Report the conflict to the assigned charge nurse of the unit.
• C. Report the conflict to the nurse manager of the unit.
• D. Discuss the conflict with the other nurse to attempt resolution of the issue.

Correct answer: B

Rationale: In this scenario, the most appropriate way for the LPN to proceed is to report the conflict to the assigned charge nurse of the unit. Following the chain of command is crucial in a professional setting to address conflicts effectively. Reporting the issue to the charge nurse, who is the immediate supervisor, allows for a structured approach to resolving the conflict. Reporting directly to higher levels such as the director of nursing or nurse manager may bypass the appropriate hierarchy and could create unnecessary tension. Attempting to resolve the issue independently with the other nurse may not be effective if previous attempts have failed, making it essential to involve the immediate supervisor.

5. A case manager is serving on a community task force on violence in schools. The members of the task force are planning to develop interventions to help prevent violence. According to the nursing process, which is the first activity that the case manager would suggest to the task force?

• A. Teaching schoolchildren about the dangers of school violence
• B. Conducting a community survey to assess community perceptions regarding school violence
• C. Looking at what other communities are doing about school violence
• D. Distributing flyers that identify the causes of school violence to families in the community

Correct answer: B

Rationale: The correct answer is to conduct a community survey to assess community perceptions regarding school violence. In the nursing process, assessment is always the first step. By conducting a survey, the task force can gather important data about how the community perceives school violence, which is essential for developing effective interventions. Choices A, C, and D involve actions that come after the assessment phase. Teaching schoolchildren about the dangers of violence and distributing flyers are important activities but should come after understanding the community's perceptions and needs. Looking at what other communities are doing is valuable but should also follow a thorough assessment of the specific community's needs and perceptions.

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