Nursing Elites

1. When assessing a client with glaucoma, a nurse expects which of the following findings?

• A. Complaints of double vision
• B. Complaints of halos around lights
• C. Intraocular pressure of 15 mm Hg
• D. Soft globe on palpation

Correct answer: B

Rationale: When assessing a client with glaucoma, a common finding is complaints of halos around lights. Other symptoms of glaucoma include loss of peripheral vision or blind spots, reddened sclera, firm globe, decreased accommodation, and occasional eye pain. Glaucoma may be asymptomatic until permanent damage to the optic nerve and retina occurs. Double vision is not a typical symptom of glaucoma. In terms of intraocular pressure, normal levels range from 10 to 21 mm Hg, making an intraocular pressure of 15 mm Hg within the normal range. A soft globe on palpation is not a typical finding in glaucoma.

2. The home health nurse is planning for the day's visits. Which client should be seen first?

• A. The 78-year-old who had a gastrectomy 3 weeks ago with a PEG tube
• B. The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin liquid suspension
• C. The 50-year-old with MRSA being treated with Vancomycin via a PICC line
• D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter

Correct answer: D

Rationale: The priority client is the 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter. This client is at the highest risk for complications and requires immediate attention. Choice C, the 50-year-old with MRSA being treated with Vancomycin via a PICC line, is incorrect as Vancomycin administration can be scheduled at specific times and does not indicate an urgent need for a visit. Choices A and B are also incorrect as these clients are more stable compared to the client with multiple sclerosis in need of cortisone therapy.

3. Tricyclics (Antidepressants) can sometimes have which of the following adverse effects on patients diagnosed with depression?

• A. Shortness of breath
• B. Fainting
• C. Large intestine ulcers
• D. Distal muscular weakness

Correct answer: B

Rationale: The correct answer is 'Fainting.' Tricyclic antidepressants can cause fainting and hypotension as adverse effects. Shortness of breath (Choice A) is not a common side effect of tricyclics. Large intestine ulcers (Choice C) are not typically associated with tricyclic antidepressants. Distal muscular weakness (Choice D) is not a common adverse effect of tricyclics but is commonly associated with other medications.

4. The client is scheduled for a pericentesis. Which instruction should be given to the client before the exam?

• A. "You will need to lie flat during the exam."?
• B. "You need to empty your bladder before the procedure."?
• C. "You will be asleep during the procedure."?
• D. "The doctor will inject a medication to treat your illness during the procedure."?

Correct answer: B

Rationale: The client scheduled for a pericentesis should be instructed to empty the bladder to prevent the risk of bladder puncture when the needle is inserted. A pericentesis involves removing fluid from the peritoneal cavity. The client is typically positioned sitting up or leaning over a table, making answer A incorrect. During a pericentesis, the client is usually awake, so answer C is incorrect. Medications are not commonly injected into the peritoneal cavity during this procedure, making answer D incorrect. However, it's important to note that the administration of medications during the procedure could vary based on specific circumstances.

5. While the client is receiving quinidine, the nurse should monitor the ECG for:

• A. Peaked P wave
• B. Elevated ST segment
• C. Inverted T wave
• D. Prolonged QT interval

Correct answer: D

Rationale: Quinidine can cause widened Q-T intervals and heart block, leading to a prolonged QT interval on the ECG. Other signs of myocardial toxicity associated with quinidine include notched P waves and widened QRS complexes. Common side effects of quinidine include diarrhea, nausea, and vomiting, while less common effects may include tinnitus, vertigo, headache, visual disturbances, and confusion. Monitoring for a prolonged QT interval is crucial due to the potential risk of serious arrhythmias. Choices A, B, and C are not typically associated with the use of quinidine and are therefore incorrect in this context.

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