Nursing Elites

1. When a drug is listed as Category X and prescribed to women of child-bearing age/capacity, the nurse and the interdisciplinary team should counsel the client that:

• A. Pregnancy tests are not reliable while taking the drug.
• B. She must use a reliable form of birth control.
• C. She should not take the Category X drug on days she has intercourse.
• D. She must follow up with an endocrinologist.

Correct answer: B

Rationale: When a drug is categorized as Category X, it signifies that there are significant risks of fetal abnormalities if taken during pregnancy. For this reason, women of child-bearing age/capacity should use reliable forms of birth control to prevent pregnancy while on the medication. This ensures that the client avoids the potential harm to the fetus. Option A is incorrect because pregnancy tests are not unreliable due to the drug, but rather the risk is related to potential harm to the fetus. Option C is incorrect as avoiding the drug only on days of intercourse does not provide sufficient protection against pregnancy. Option D is incorrect as the need for an endocrinologist is not directly related to the use of Category X drugs.

2. When providing perineal care to a female client, how should the nurse perform the procedure?

• A. with gloves, washing the perineal area from front to back
• B. without gloves, having the client perform all care
• C. with gloves, washing the perineal area from back to front
• D. without gloves, pouring water from a sterile bottle

Correct answer: A

Rationale: When providing perineal care to a female client, the nurse should wear gloves and wash the perineal area from front to back. This technique helps prevent the introduction of E. coli and other bacteria into the urethra, reducing the risk of urinary tract infections. Washing from back to front can introduce bacteria from the anal area to the urethra, leading to infections. Performing the procedure without gloves or having the client perform all care does not adhere to infection control practices. Pouring water from a sterile bottle alone may not ensure proper cleansing and infection prevention. Therefore, choices B, C, and D are incorrect as they do not follow proper perineal care guidelines.

3. A nursing assistant who has been employed in the long-term care center for 8 weeks is consistently taking extended lunch breaks. The nursing assistant's behavior has caused problems with client care during lunch hours. What is the appropriate way for the nurse to deal with this situation?

• A. Ignoring the situation
• B. Documenting the problem in the nursing assistant's personnel file
• C. Asking other staff members to cover for the nursing assistant
• D. Meeting with the nursing assistant to discuss the behavior and initiate problem-solving measures

Correct answer: D

Rationale: Taking extended lunch breaks is an unacceptable behavior, especially when it affects client care. The appropriate way for the nurse to deal with this situation is to meet with the nursing assistant to discuss the behavior and initiate problem-solving measures. This direct approach allows for open communication and the opportunity to address the issue effectively. Ignoring the situation (Choice A), asking other staff members to cover (Choice C), or documenting the problem in the nursing assistant's personnel file (Choice B) are not effective solutions. Ignoring the behavior does not address the issue, asking others to cover may not solve the problem at its root, and documenting the problem should come after attempting to resolve the issue through communication and problem-solving first.

4. Which of the following conditions has a severe complication of respiratory failure?

• A. Bell's palsy
• B. Guillain-Barr� syndrome
• C. Trigeminal neuralgia
• D. Tetanus

Correct answer: B

Rationale: Guillain-Barr� syndrome is characterized by a severe complication of respiratory failure due to the involvement of the peripheral nerves that control breathing. While Bell's palsy, trigeminal neuralgia, and tetanus are also conditions affecting peripheral nerves, they do not typically lead to respiratory failure like Guillain-Barr� syndrome. Bell's palsy causes facial muscle weakness, trigeminal neuralgia results in severe facial pain, and tetanus leads to muscle stiffness and spasms, but none of these conditions directly involve respiratory failure.

5. Distribution of a drug to various tissues depends on the amount of cardiac output to each type of tissue. Which tissue would receive the highest amount of cardiac output and thus the highest amount of a drug?

• A. skin
• B. adipose tissue
• C. skeletal muscle
• D. myocardium

Correct answer: D

Rationale: The correct answer is 'myocardium.' Highly perfused tissues include vital organs like the brain, heart, kidneys, adrenal glands, and liver. The myocardium, being heart muscle, receives the highest amount of cardiac output and thus the highest amount of a drug. Choices A, B, and C are incorrect because the skin and adipose tissue are poorly perfused, while skeletal muscle is less perfused compared to vital organs like the myocardium.

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