Nursing Elites

1. A woman in her third trimester complains of severe heartburn. What is appropriate teaching by the nurse to help the woman alleviate these symptoms?

• A. Drink small amounts of liquids frequently
• B. Eat the evening meal at least 2-3 hours before bedtime
• C. Take sodium bicarbonate after each meal
• D. Sleep with head propped on several pillows

Correct answer: D

Rationale: During the third trimester, many women experience heartburn due to the pressure of the growing uterus on the stomach. Elevating the head while sleeping can help prevent gastric contents from refluxing back into the esophagus, thus reducing heartburn symptoms. Drinking small amounts of liquids frequently may exacerbate heartburn by increasing stomach distension. Eating the evening meal just before retiring can also worsen heartburn symptoms as lying down shortly after eating can promote reflux. Taking sodium bicarbonate after each meal is not recommended as it can disrupt the body's natural pH balance and lead to other complications.

2. When caring for an asthmatic patient with an early-phase reaction, which of the following is indicative of an early-phase reaction?

• A. Rapid bronchospasms
• B. Inflammatory epithelial lesions
• C. Increased secretions
• D. Increased mucosal edema

Correct answer: A

Rationale: Rapid bronchospasms are a symptom of an early-phase reaction in an asthmatic patient. During the early phase, bronchospasms occur due to immediate hypersensitivity reactions. Inflammatory epithelial lesions, increased secretions, and increased mucosal edema are typically seen in late-phase reactions as part of the inflammatory response that occurs later. Therefore, rapid bronchospasms are most indicative of an early-phase reaction.

3. The patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse?

• A. The oxygen saturation is 94%.
• B. The blood pressure is 98/56 mm Hg.
• C. The patient's central IV line is disconnected.
• D. The international normalized ratio (INR) is prolonged.

Correct answer: C

Rationale: The most immediate action required by the nurse is to address the disconnected central IV line delivering epoprostenol (Flolan). Epoprostenol has a short half-life of 6 minutes, necessitating immediate reconnection to prevent rapid clinical deterioration. While oxygen saturation, blood pressure, and INR are important parameters requiring monitoring and intervention, the priority lies in ensuring the continuous delivery of the critical medication to stabilize the patient's condition.

4. A child is diagnosed with a Greenstick Fracture. Which of the following most accurately describes the broken bone?

• A. compound fracture of the fibula
• B. a partial break in a long bone
• C. fracture of the growth plate of the ulna near the wrist
• D. Colles fracture of the tibia

Correct answer: B

Rationale: A Greenstick Fracture is commonly found in children due to their bones being more flexible. This type of fracture occurs when a bone bends and partially breaks, resembling what happens when a green stick from a tree is bent in half. Therefore, the most accurate description of a Greenstick Fracture is 'a partial break in a long bone.' Choice A, 'compound fracture of the fibula,' is incorrect as a Greenstick Fracture is not a compound fracture. Choice C, 'fracture of the growth plate of the ulna near the wrist,' is incorrect as it describes a different type of fracture. Choice D, 'Colles fracture of the tibia,' is incorrect as it refers to a specific type of fracture in a different bone.

5. A patient with Glaucoma is verbalizing his daily medication routine to the nurse. He states he has two different eye drop medications, both every twelve hours. He washes his hands, instills the drops, closes his eyes gently, and presses his finger to the corner of his eye nearest his nose. After waiting 1 minute with his eyes closed, he instills the other medication in the same way. What is the nurse's best response?

• A. ''You should wait more than 1 minute between different medications.''
• B. ''Your routine is very good! Can you demonstrate it for me?''
• C. ''It is actually not the best practice to close your eyes after instilling eye drops.''
• D. ''You should actually be pressing your finger in the other corner of the eye.''

Correct answer: A

Rationale: It is recommended to wait 10-15 minutes between different eye drop medications to give them time to absorb and avoid one medication washing another one out. Choice A is the correct response as the patient should wait more than 1 minute between administering different eye drop medications. Choice B is incorrect as the routine described by the patient needs improvement. Choice C is inaccurate as closing the eyes after instilling eye drops is a best practice to ensure proper absorption. Choice D is incorrect as pressing the finger to the corner of the eye nearest the nose is the correct technique.

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