Nursing Elites

1. A patient who is receiving chemotherapy for breast cancer develops thrombocytopenia. What should the nurse include in the care plan?

• A. Encourage light exercise.
• B. Avoid intramuscular injections.
• C. Do not administer aspirin.
• D. Use a soft toothbrush for oral care.

Correct answer: B

Rationale: Thrombocytopenia is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. To minimize this risk, patients with thrombocytopenia should avoid activities that can cause injury or bleeding, such as intramuscular injections. Encouraging light exercise can be beneficial, as it promotes circulation without increasing the risk of trauma. However, avoiding intramuscular injections is crucial to prevent bleeding episodes. Aspirin should be avoided as it can further impair platelet function, exacerbating the condition. Using a soft toothbrush for oral care is recommended to prevent gum bleeding in patients with thrombocytopenia.

2. A client with chronic renal failure is scheduled to receive epoetin alfa (Epogen). Which laboratory result should the nurse review before administering the medication?

• A. Blood urea nitrogen (BUN)
• B. Creatinine clearance
• C. Hemoglobin level
• D. Serum potassium

Correct answer: C

Rationale: The correct answer is to review the hemoglobin level before administering epoetin alfa (Epogen) to assess its effectiveness in stimulating red blood cell production. Hemoglobin level is a crucial indicator to monitor in clients with chronic renal failure receiving this medication. Choice A (Blood urea nitrogen) and Choice B (Creatinine clearance) are commonly monitored in renal failure but are not specifically relevant to assessing the effectiveness of epoetin alfa. Choice D (Serum potassium) is important to monitor due to potential imbalances in renal failure, but it is not directly related to evaluating the effectiveness of epoetin alfa.

3. A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?

• A. Nitrofurantoin (Macrodantin) orally.
• B. Erythropoietin (Epogen) intravenously.
• C. Kayexalate retention enema.
• D. Azathioprine (Imuran) orally.

Correct answer: C

Rationale: In acute renal failure with high serum potassium levels, the healthcare provider is likely to prescribe a Kayexalate retention enema. Kayexalate is a medication used to lower elevated potassium levels by promoting potassium excretion through the gastrointestinal tract, thus aiding in the management of hyperkalemia in clients with renal failure.

4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which intervention should the nurse implement to ensure the client's safety?

• A. Increase the oxygen flow rate to 6 liters/minute if the client is short of breath.
• B. Instruct the client to breathe deeply and cough frequently.
• C. Use a nasal cannula to deliver oxygen at a low flow rate.
• D. Encourage the client to remove the oxygen when eating or drinking.

Correct answer: C

Rationale: Using a nasal cannula to deliver oxygen at a low flow rate is the appropriate intervention for clients with COPD receiving oxygen therapy. High flow rates can lead to respiratory depression in COPD patients. This intervention helps maintain a safe and controlled oxygen delivery to prevent potential complications associated with high oxygen flow rates.

5. A client diagnosed with major depressive disorder refuses to get out of bed, eat, or participate in group therapy. Which intervention is most important for the nurse to implement?

• A. Offer the client high-calorie snacks and frequent small meals.
• B. Ask the client why they are not participating in therapy.
• C. Sit with the client and offer support without demanding participation.
• D. Encourage the client to discuss their feelings of hopelessness.

Correct answer: C

Rationale: In cases of major depressive disorder where the client is non-participatory and withdrawn, sitting with the client and providing support without pressuring them to engage in activities like eating or therapy is crucial. This approach respects the client's current state, builds trust, and creates a supportive environment that can eventually lead to the client opening up and accepting help.

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