Nursing Elites

1. What information should the nurse include in the discharge teaching plan of a client with low back pain who is taking cyclobenzaprine to control muscle spasms?

• A. Take this medication with or without food
• B. Avoid using heat or ice on injured muscles while taking this medication
• C. Use cold and allergy medications only as directed by a healthcare provider
• D. Discontinue all nonsteroidal anti-inflammatory medications

Correct answer: C

Rationale: The correct answer is C: 'Use cold and allergy medications only as directed by a healthcare provider.' It is essential to inform the client not to self-medicate with cold and allergy medications or make changes without consulting a healthcare provider to prevent potential drug interactions or adverse effects. Choice A is incorrect because cyclobenzaprine can be taken with or without food, so there is no specific requirement to take it on an empty stomach. Choice B is incorrect because using heat or ice on injured muscles while taking cyclobenzaprine is generally safe and can help with symptom management. Choice D is also incorrect because discontinuing nonsteroidal anti-inflammatory medications should be done under the guidance of a healthcare provider, but it is not a direct concern related to taking cyclobenzaprine for muscle spasms.

2. A group of nurses implemented a pilot study to evaluate a proposed evidence-based change to providing client care. Evaluation indicates successful outcomes, and the nurses want to integrate the change throughout the facility. Which action should be taken? (Select all that apply)

• A. Invite data review by the quality improvement department
• B. Submit a sentinel event report to the research committee
• C. Propose clinical practice guidelines to the nursing committee
• D. Arrange in-service training through the educational department

Correct answer: A

Rationale: Inviting data review by the quality improvement department is crucial to ensure the quality and efficacy of the proposed evidence-based change. This step allows for a comprehensive analysis of the data collected during the pilot study. Proposing clinical practice guidelines to the nursing committee is also essential for integrating the successful change into routine practice. In-service training through the educational department will help educate staff and ensure they are proficient in implementing the new practices. Submitting a sentinel event report to the research committee is not necessary in this scenario as the outcomes were successful, and there were no adverse events that would warrant such a report. Choices B, C, and D are not as relevant in this context compared to inviting data review by the quality improvement department, which is a crucial step in ensuring the success of the proposed change.

3. The unlicensed assistive personnel (UAP) has applied a gown and gloves and secured the tops of the gloves over the gown sleeves. What action should the nurse take?

• A. Confirm that the gown is tied securely at the neck and waist
• B. Remind the UAP to wash hands frequently while in the room
• C. Assist the UAP with application of the face mask or face shield
• D. Help the UAP reposition the gown sleeve over the gloves edges

Correct answer: D

Rationale: Proper application of personal protective equipment (PPE) is crucial to maintain infection control. In this scenario, the nurse should help the UAP reposition the gown sleeve over the gloves' edges. This action ensures that the gown properly covers the gloves, reducing the risk of contamination. Choices A, B, and C are incorrect because the primary concern is to address the improper application of PPE by repositioning the gown sleeves over the gloves, not checking other aspects of PPE or reminding about hand hygiene.

4. The healthcare provider is evaluating a client for potential dehydration. Which assessment finding is most indicative of fluid volume deficit?

• A. Moist mucous membranes
• B. Increased urine output
• C. Decreased skin turgor
• D. Elevated blood pressure

Correct answer: C

Rationale: Corrected Rationale: Decreased skin turgor is a classic sign of dehydration. When someone is dehydrated, the skin loses its elasticity and becomes less turgid. This change is easily assessed by gently pinching and pulling up the skin on the back of the hand or forearm. If the skin remains elevated or tents rather than quickly returning to its normal position, it indicates dehydration. Moist mucous membranes (Choice A) are actually a sign of adequate hydration. Increased urine output (Choice B) can be a sign of dehydration, but decreased skin turgor is a more specific indicator. Elevated blood pressure (Choice D) is not typically associated with fluid volume deficit and may indicate other health issues.

5. A client with acute renal failure (ARF) is admitted for uncontrolled type 1 diabetes mellitus and hyperkalemia. The nurse administers an IV dose of regular insulin per sliding scale. Which intervention is the most important for the nurse to include in this client’s plan of care?

• A. Monitor the client’s cardiac activity via telemetry.
• B. Maintain venous access with an infusion of normal saline.
• C. Assess glucose levels via finger stick every 4 to 6 hours.
• D. Evaluate hourly urine output for the return of normal renal function.

Correct answer: A

Rationale: Monitoring cardiac activity is crucial in this scenario because hyperkalemia can lead to serious cardiac dysrhythmias, which can be life-threatening. Regular monitoring of the client’s cardiac activity via telemetry allows for early detection of any potential cardiac complications. Maintaining venous access with a normal saline infusion is important for hydration but does not address the immediate risk of cardiac dysrhythmias posed by hyperkalemia. Assessing glucose levels is essential in diabetes management but is not the priority when dealing with hyperkalemia-induced cardiac risks. Evaluating hourly urine output for the return of normal renal function is important in ARF but is not as urgent as monitoring the client's cardiac activity in the context of hyperkalemia.

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