Nursing Elites

1. The physician has ordered sodium warfarin (Coumadin) for the client with thrombophlebitis. The order should be entered to administer the medication at:

• A. 900
• B. 1200
• C. 1700
• D. 2100

Correct answer: C

Rationale: Sodium warfarin is typically administered in the late afternoon, around 1700 hours. This timing allows for accurate bleeding times to be drawn in the morning. Administering it at 0900 (choice A) would not align with this schedule and may affect the monitoring of bleeding times. Choice B (1200) is midday, which is not the recommended time for sodium warfarin administration. Choice D (2100) is in the evening, which is also not ideal. Therefore, the correct time for administering sodium warfarin is 1700 (choice C).

2. A health care worker is concerned about a new mother being overwhelmed by caring for her infant. The health care worker should:

• A. immediately contact child protective services
• B. provide the mother with literature about child care
• C. consult a therapist to help the mother work out her fears
• D. refer the mother to parenting classes

Correct answer: D

Rationale: Prevention of child abuse is centered on teaching parents how to care for their child and cope with the demands of infant care. Parenting classes can help build self-confidence, self-esteem, and coping skills. Parents benefit by understanding the developmental needs of their children, while learning how to manage their home environment more effectively. The classes also increase the parents' social contacts and teach about community resources. Contacting child protective services (Choice A) is not appropriate in this scenario as there is no indication of abuse or neglect. Providing literature (Choice B) may not be as effective as parenting classes in addressing the mother's concerns. Consulting a therapist (Choice C) may be beneficial for underlying mental health issues, but parenting classes specifically focus on child care and coping skills, making Choice D the most suitable option in this situation.

3. What should the charge nurse do after overhearing the patient care assistant speaking harshly to the client with dementia?

• A. Change the patient care assistant's assignment
• B. Explore the interaction with the patient care assistant
• C. Discuss the matter with the client's family
• D. Initiate a group session with the patient care assistant

Correct answer: B

Rationale: The best action for the charge nurse to take is to explore the interaction with the patient care assistant. This step allows for clarification of the situation and direct addressing of the issue. Changing the patient care assistant's assignment (choice A) might be necessary, but understanding the situation should come first. Discussing the matter with the client's family (choice C) as an initial step could escalate the situation. Initiating a group session with the patient care assistant (choice D) could be considered later as a preventive measure to avoid similar incidents in the future.

4. 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.

5. The client returns to the unit from surgery with a blood pressure of 90/50, pulse 132, respirations 30. Which action by the nurse should receive priority?

• A. Continue monitoring the vital signs
• B. Contact the physician
• C. Ask the client how they feel
• D. Ask the LPN to continue post-op care

Correct answer: B

Rationale: The priority action for the nurse is to contact the physician immediately due to the client's abnormal vital signs. A blood pressure of 90/50, pulse of 132, and respirations of 30 indicate instability and require prompt medical attention. Continuing to monitor vital signs, as in choice A, may lead to a delay in necessary interventions. Asking the client how they feel, as in choice C, provides subjective data and does not address the urgent need for medical intervention. Involving the LPN, as in choice D, is not appropriate in this critical situation where the client's condition is unstable and requires immediate physician assessment and intervention.

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