Nursing Elites

1. The nurse is assisting the RN with discharge instructions for a client with an implantable defibrillator. What discharge instruction is essential?

• A. "You can eat food prepared in a microwave."?
• B. "You should avoid moving the shoulder on the side of the defibrillator site for 6 weeks."?
• C. "You should use your cellphone on your right side."?
• D. "You will be able to fly on a commercial airliner with the defibrillator in place."?

Correct answer: C

Rationale: The essential discharge instruction for a client with an implantable defibrillator is to use any battery-operated machinery on the opposite side, including cellphones. This is to prevent interference with the device. Additionally, the client should monitor their pulse rate and report any dizziness or fainting, which could indicate issues with the defibrillator. Choices A, B, and D are incorrect because clients with implantable defibrillators can eat food prepared in the microwave, move their shoulder on the affected side after the initial healing period, and are allowed to fly on commercial airliners with the defibrillator in place.

2. A client with a diagnosis of Schizophrenia has been released from an acute care setting. The client had a prolonged recovery from relapse. One of the parents says to the discharge nurse, 'I do not understand what is going on. The hospital said she was better, but all she does is sit around all day and smoke. We cannot get her to go to the vocational training you arranged.' The nurse recognizes that more teaching is needed about

• A. the pathophysiology and behavioral manifestations of schizophrenia.
• B. support groups that can help the parents cope with their frustration.
• C. the prolonged recovery time and side effects of medications to prevent relapse.
• D. motivational techniques that are effective in engaging clients with schizophrenia.

Correct answer: C

Rationale: The nurse conducting discharge teaching must emphasize the extended recovery process and the potential side effects of medications used to prevent relapse in individuals with schizophrenia. In this scenario, it is crucial for the parents to understand that the client's behavior may be influenced by the medication's sedative qualities and the time required for full recovery. While support groups can assist caregivers in coping with their emotions and providing better care, the priority here is educating on the recovery process and medication effects. Motivational techniques are beneficial but may not be the immediate focus in this situation.

3. During the history assessment of an 80-year-old client, which statement made by the client might indicate a possible fluid and electrolyte imbalance?

• A. "My skin is always so dry."?
• B. "I often use a laxative for constipation."?
• C. "I have always liked to drink a lot of iced tea."?
• D. "I sometimes have a problem with dribbling urine."?

Correct answer: B

Rationale: The correct answer is "I often use a laxative for constipation." Frequent use of laxatives can lead to diarrhea and electrolyte loss, indicating a possible fluid and electrolyte imbalance. Statements A, C, and D are not directly related to fluid and electrolyte imbalance. Statement A about dry skin may suggest dehydration, but it is less specific to electrolyte imbalance than the frequent use of laxatives. Statement C about drinking a lot of iced tea could potentially relate to fluid intake, but it doesn't directly indicate an imbalance. Statement D about dribbling urine is more indicative of a potential urinary issue rather than a fluid and electrolyte imbalance.

4. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug might be absorbed. This process is known as:

• A. hepatic clearance.
• B. total clearance.
• C. enterohepatic cycling.
• D. first-pass effect.

Correct answer: C

Rationale: The correct answer is 'enterohepatic cycling.' This process involves drugs being excreted into bile, delivered to the intestines, reabsorbed into the circulation, and can prolong the drug's presence in the body. 'Hepatic clearance' (Choice A) refers to the amount of drug eliminated by the liver. 'Total clearance' (Choice B) is the sum of all types of clearance including renal, hepatic, and respiratory. 'First-pass effect' (Choice D) is the amount of drug absorbed from the GI tract and metabolized by the liver before entering circulation, reducing the amount of drug available for systemic circulation.

5. Following the change of shift report, when can or should the nurse alter or modify the plan?

• A. halfway through the shift
• B. at the end of the shift before handing over
• C. when needs change
• D. after the top-priority tasks have been completed

Correct answer: C

Rationale: The correct answer is 'when needs change.' The nurse should be flexible and adjust the plan as necessary when the needs of the patients change. This ensures that care is provided effectively and efficiently. Choices A, B, and D are incorrect because altering the plan based on time intervals, solely at the end of the shift, or after completing top-priority tasks may not align with the current needs of the patients.

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