Nursing Elites

1. The healthcare provider should observe most closely for drug toxicity when a client receives a medication that has which characteristic?

• A. Low bioavailability
• B. Rapid onset of action
• C. Short half-life
• D. Narrow therapeutic index

Correct answer: D

Rationale: The correct answer is D, narrow therapeutic index. Narrow therapeutic index (NTI) drugs are defined as those drugs where small differences in dose or blood concentration may lead to serious therapeutic failures or adverse drug reactions. Choices A, B, and C are not directly related to the risk of drug toxicity. Low bioavailability (Choice A) refers to the amount of drug that enters the bloodstream unchanged after administration. Rapid onset of action (Choice B) and short half-life (Choice C) are characteristics related to drug effectiveness and metabolism but do not necessarily indicate a higher risk of drug toxicity.

2. While taking vital signs, a critically ill male client grabs the nurse's hand and asks the nurse not to leave. What action is best for the nurse to take?

• A. Pull up a chair and sit beside the client's bed.
• B. Reassure the client that you will return shortly.
• C. Ask another nurse to stay with the client.
• D. Continue taking vital signs and then leave the room.

Correct answer: A

Rationale: The best action for the nurse to take in this situation is to pull up a chair and sit beside the client's bed. By doing so, the nurse can provide emotional support and comfort to the critically ill patient who is feeling vulnerable. Sitting with the client also shows empathy and a willingness to listen to the client's needs. Reassuring the client that the nurse will return shortly (Choice B) may not address the immediate need for emotional support. Asking another nurse to stay with the client (Choice C) may not establish the same level of connection and comfort as sitting with the client personally. Continuing to take vital signs and then leaving the room (Choice D) disregards the client's emotional needs in that moment.

3. A client with a history of rheumatoid arthritis is prescribed methotrexate. Which laboratory value should the nurse monitor closely?

• A. Liver function tests
• B. Complete blood count
• C. Serum creatinine
• D. Prothrombin time

Correct answer: C

Rationale: Serum creatinine should be closely monitored in a client receiving methotrexate, as the medication can cause nephrotoxicity. Monitoring serum creatinine levels helps assess kidney function and detect potential nephrotoxic effects of methotrexate. Liver function tests (Choice A) are important to monitor for hepatotoxicity caused by methotrexate. While methotrexate can cause bone marrow suppression, leading to anemia, leukopenia, and thrombocytopenia, monitoring a complete blood count (Choice B) is essential but not the priority in this case. Prothrombin time (Choice D) is not typically affected by methotrexate therapy and is not the primary laboratory value to monitor in this situation.

4. Which needle should the nurse use to administer intravenous fluids (IV) via a client's implanted port?

• A. The one with the clamp and no needle
• B. A butterfly needle
• C. A non-coring (Huber) needle
• D. A standard hypodermic needle

Correct answer: C

Rationale: The correct needle to use for administering intravenous fluids via an implanted port is a non-coring (Huber) needle. This type of needle is specifically designed to access implanted ports without coring the septum, which helps prevent damage. Choice A, the one with the clamp and no needle, is incorrect as it does not describe a needle suitable for accessing an implanted port. Choice B, a butterfly needle, is not typically used for accessing implanted ports. Choice D, a standard hypodermic needle, is not ideal for accessing ports as it can damage the septum.

5. A preschooler with constipation needs to increase fiber intake. Which snack suggestion should the nurse provide?

• A. Oatmeal cookies
• B. Cheese sticks
• C. Yogurt
• D. Apple slices

Correct answer: A

Rationale: Oatmeal cookies are the best snack suggestion for a preschooler with constipation needing to increase fiber intake. Oatmeal is high in fiber, which helps relieve constipation. Cheese sticks, yogurt, and apple slices are not as high in fiber content as oatmeal and may not be as effective in addressing the constipation issue in this scenario.

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