Nursing Elites

1. The nurse is caring for a 36-year-old patient with pancreatic cancer. Which nursing action is the highest priority?

• A. Offer psychological support for depression.
• B. Offer high-calorie, high-protein dietary choices.
• C. Administer prescribed opioids to relieve pain as needed.
• D. Teach about the need to avoid scratching any pruritic areas.

Correct answer: C

Rationale: The correct answer is to administer prescribed opioids to relieve pain as needed. Pain management is the highest priority in this scenario as effective pain control is essential for the patient's overall well-being. Pain relief will not only improve the patient's comfort but also enhance their ability to eat, follow dietary recommendations, and be open to psychological support. Offering psychological support for depression (Choice A) is important but addressing pain takes precedence. While providing high-calorie, high-protein dietary choices (Choice B) is crucial, it is secondary to managing pain. Teaching about the need to avoid scratching pruritic areas (Choice D) is relevant but not the highest priority in this situation where pain management is critical for the patient's quality of life.

2. Which of these clients is likely to receive sublingual morphine?

• A. A 75-year-old woman in a hospice program
• B. A 40-year-old man who just had throat surgery
• C. A 20-year-old woman with trigeminal neuralgia
• D. A 60-year-old man who has a painful incision

Correct answer: A

Rationale: The correct answer is a 75-year-old woman in a hospice program. Sublingual morphine is commonly used in hospice care because patients may have difficulty swallowing, and intravenous access can be uncomfortable and not ideal for palliative care. Choice B, a 40-year-old man who just had throat surgery, is less likely to receive sublingual morphine as he may be able to swallow, and other pain management options may be more suitable. Choice C, a 20-year-old woman with trigeminal neuralgia, would typically require specific medications targeting neuropathic pain rather than sublingual morphine. Choice D, a 60-year-old man with a painful incision, may benefit from localized pain relief or other systemic pain management options, but sublingual morphine is not usually the first choice for this type of pain.

3. When orally administering alendronate (Fosamax), a bisphosphonate drug, to a largely bed-bound patient being treated for osteoporosis, what is the most important nursing consideration?

• A. Sit the head of the bed up for 30 minutes after administration
• B. Give the patient a small amount of water to drink
• C. Feed the patient soon, at most 10 minutes after administration
• D. Assess the patient for back pain or abdominal pain

Correct answer: A

Rationale: The correct nursing consideration when administering bisphosphonates like alendronate is to sit the head of the bed up for 30 minutes after administration. Bisphosphonates are known to cause esophageal irritation, which can lead to esophagitis. By sitting upright, the patient reduces the time the medication spends in the esophagus, decreasing the risk of irritation and potential adverse effects. Giving the patient water to drink or feeding them immediately after administration can increase the risk of esophageal irritation. Assessing the patient for back pain or abdominal pain is important but not the most critical consideration during drug administration.

4. A patient's chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute?

• A. Vomiting
• B. Extreme Thirst
• C. Weight gain
• D. Acetone breath smell

Correct answer: C

Rationale: In acute ketoacidosis, a patient typically experiences rapid weight loss due to the body burning fat and muscle for energy in the absence of sufficient insulin. Therefore, weight gain would not be expected. Vomiting may occur due to the metabolic disturbances associated with ketoacidosis. Extreme thirst is a common symptom as the body tries to compensate for dehydration. Acetone breath smell is a classic sign of ketoacidosis as acetone is one of the ketones produced during this condition.

5. While suctioning the endotracheal tube of an adult client, what level of pressure should the nurse apply?

• A. 70-80 mmHg
• B. 100-120 mmHg
• C. 150-170 mmHg
• D. 200 mmHg

Correct answer: B

Rationale: When suctioning the endotracheal tube of an adult client, the nurse should set the suction apparatus at a level no higher than 150 mmHg, with a preferable level between 100 and 120 mmHg. Suction pressure that is too high can contribute to the client's hypoxia. Alternatively, too low suction pressure may not clear adequate amounts of secretions. Choice A (70-80 mmHg) is too low and may not effectively clear secretions. Choices C (150-170 mmHg) and D (200 mmHg) are too high and can potentially harm the client by causing hypoxia or damaging the airway.

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