Nursing Elites

1. The nurse is caring for a client who is postoperative following a hip replacement. Which intervention is most important to prevent dislocation of the prosthesis?

• A. Keep the client in a low Fowler's position.
• B. Maintain hip abduction with pillows.
• C. Encourage early ambulation.
• D. Place the client in a prone position.

Correct answer: B

Rationale: Maintaining hip abduction with pillows is the most important intervention to prevent dislocation of the hip prosthesis postoperatively. This position helps keep the hip joint stable and prevents excessive internal rotation, which can lead to dislocation. Keeping the client in a low Fowler's position (Choice A) does not provide the necessary support and stability for the hip joint. While early ambulation (Choice C) is important for preventing complications such as blood clots and promoting circulation, it is not the most crucial intervention for preventing dislocation. Placing the client in a prone position (Choice D) can be harmful and increase the risk of dislocation.

2. The healthcare provider is caring for a client with a chest tube following a pneumothorax. Which assessment finding should be reported to the healthcare provider immediately?

• A. Continuous bubbling in the water seal chamber
• B. Absence of drainage in the collection chamber
• C. Tidaling in the water seal chamber
• D. Presence of subcutaneous emphysema around the insertion site

Correct answer: A

Rationale: Continuous bubbling in the water seal chamber should be reported to the healthcare provider immediately. This finding may indicate an air leak, which can compromise the effectiveness of the chest tube in re-expanding the lung. Absence of drainage in the collection chamber (choice B) may signify that the chest tube is blocked, but it does not pose an immediate threat to the client's condition. Tidaling in the water seal chamber (choice C) is an expected finding and indicates proper functioning of the chest tube system. Presence of subcutaneous emphysema around the insertion site (choice D) suggests air leakage but is not as urgent as continuous bubbling in the water seal chamber.

3. The nurse explains the 2-week dosage prescription of prednisone (Deltasone) to a client who has poison ivy over multiple skin surfaces. What should the nurse emphasize about the dosing schedule?

• A. Decrease the dosage daily as prescribed
• B. Monitor oral temperature daily
• C. Take the prednisone with meals
• D. Return for blood glucose monitoring in one week

Correct answer: A

Rationale: The correct answer is A: 'Decrease the dosage daily as prescribed.' Tapering the dosage of prednisone is crucial to prevent withdrawal symptoms and minimize the side effects of corticosteroid therapy. Decreasing the dosage gradually over time allows the body to adjust and reduces the risk of adrenal insufficiency. Choices B, C, and D are incorrect. Monitoring oral temperature daily, taking prednisone with meals, or returning for blood glucose monitoring in one week are not specific to the dosing schedule of prednisone for poison ivy treatment.

4. A client with hypothyroidism is taking levothyroxine (Synthroid). Which symptom should prompt the nurse to notify the healthcare provider?

• A. Weight gain
• B. Bradycardia
• C. Nervousness and tremors
• D. Fatigue

Correct answer: C

Rationale: The correct answer is C: Nervousness and tremors. These symptoms may indicate hyperthyroidism resulting from excessive dosing of levothyroxine. Weight gain (Choice A) is a common symptom of hypothyroidism and may indicate undertreatment or inadequate dosing. Bradycardia (Choice B) is a symptom of hypothyroidism and may improve with levothyroxine therapy; it does not typically indicate an urgent need for healthcare provider notification. Fatigue (Choice D) is a symptom of hypothyroidism and can persist even with levothyroxine treatment, so it is not a symptom that would require immediate notification of the healthcare provider.

5. A client with a history of seizures is being discharged home. Which instruction is most important for the nurse to provide?

• A. Take your medication as prescribed.
• B. Avoid driving until your condition is stable.
• C. Keep a seizure diary.
• D. Avoid alcohol consumption.

Correct answer: A

Rationale: The most important instruction for a client with a history of seizures being discharged home is to take their medication as prescribed. Consistent and timely intake of anti-seizure medication is vital in managing seizures and preventing episodes. While instructions like avoiding driving until the condition is stable, keeping a seizure diary, and avoiding alcohol consumption are important, none are as critical as ensuring proper medication adherence to control seizures effectively. Failure to take prescribed medications can lead to breakthrough seizures, compromising the patient's safety and seizure control.

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