Nursing Elites

1. How would you best evaluate the clinical usefulness of a test?

• A. Decide on using a single test for all clients and families
• B. Consider what needs to be collected and discuss with colleagues
• C. Ask the family for a test suggestion
• D. Read the statistical methods used to validate the scores

Correct answer: B

Rationale: When evaluating the clinical usefulness of a test, the best approach is to consider what specific information needs to be collected based on the clients' needs. Discussing these considerations with colleagues helps in ensuring that the chosen test is appropriate and beneficial for the individuals being assessed. Choice A is incorrect as using a single test for all clients may not account for individual differences. Choice C is incorrect as the family's suggestion alone may not align with clinical needs. Choice D is incorrect as understanding statistical methods alone may not fully capture the clinical utility of a test.

2. A nasogastric tube for suction is ordered for a neonate diagnosed with a diaphragmatic hernia. Which complication related to gastric drainage is the priority when planning care for this neonate?

• A. Weight loss
• B. Metabolic alkalosis
• C. Dehydration
• D. Hyperbilirubinemia

Correct answer: B

Rationale: Metabolic alkalosis is the priority complication to consider when a neonate with a diaphragmatic hernia is placed on gastric suction. Prolonged gastric drainage can lead to the loss of stomach acids, resulting in metabolic alkalosis, which can have serious consequences for the neonate's health.

3. The nurse provides discharge instructions to a patient prescribed verapamil SR 120mg PO daily for HTN. Which statement by the patient indicates understanding of the medication?

• A. �I will take the medication with grapefruit juice each morning.�
• B. �I should expect occasional loose stools from this medication�
• C. �I�ll need to reduce the amount of fiber in my diet�
• D. �I must swallow the pill whole.�

Correct answer: D

Rationale: �SR� indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect. Increasing fluids and dietary fiber can help prevent this adverse effect.

4. A patient in the emergency department reports taking sildenafil (Viagra) and nitroglycerin 1 hr before sexual activity. Which finding should the nurse immediately report to the physician?

• A. WBC of 3200 cells/mm³
• B. RR of 26 breaths/min
• C. Temp of 38°C
• D. BP of 70/50

Correct answer: D

Rationale: The correct answer is D: BP of 70/50. When sildenafil (Viagra) is taken with nitroglycerin, it can cause severe hypotension that is unresponsive to treatment. The combination of these medications can lead to a dangerous drop in blood pressure. It is crucial to immediately report hypotension in this scenario as it poses a significant risk to the patient's life. It is recommended to allow at least 24 hours to elapse between the last dose of sildenafil and nitroglycerin to prevent such adverse effects. The other vital signs and lab values may be abnormal but do not have the immediate life-threatening implications that severe hypotension does in this context.

5. During a home care visit for an infant diagnosed with gastroesophageal reflux, which parental action observed requires intervention by the nurse?

• A. The infant's formula is mixed with rice cereal.
• B. The mother positions the infant in a high Fowler position while feeding.
• C. After feeding, the infant is placed in a car seat.
• D. The mother administers ranitidine (Zantac) to the infant using a syringe.

Correct answer: C

Rationale: Placing an infant diagnosed with gastroesophageal reflux in a car seat after feeding can increase the risk of reflux and aspiration. The semi-upright or high Fowler position is recommended to help reduce reflux symptoms during feeding. Adding rice cereal to formula can help thicken it and reduce reflux episodes. Administering ranitidine using a syringe is a common method of oral medication administration. Therefore, the action of placing the infant in a car seat after feeding is the one that requires intervention due to the increased risk it poses.

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