Nursing Elites

1. A client in the emergency room enters the care area to start an IV. He finds a man sitting on the table, hunched over, and attempting to take deep breaths. He states, 'my chest hurts so much!' His wife is sitting on a chair in the corner, crying. Which of the following is the first action of the client?

• A. Bring the IV kit and quickly start an IV
• B. Assess his breathing and provide oxygen, if necessary
• C. Administer medication to control chest pain
• D. Talk with his wife and find out why she is crying

Correct answer: B

Rationale: In the above scenario, the first action of the nurse should be to assess the client's airway and breathing. It is crucial to address respiratory status first, as the client appears to be experiencing difficulty breathing. Providing oxygen if necessary can help support oxygenation and alleviate potential respiratory distress. Administering medication for chest pain or starting an IV can come after ensuring adequate oxygenation. Talking with the client's wife, though important for emotional support, is not the priority when the client's respiratory status needs to be assessed and managed promptly.

2. Which of the following reasons would be legal when considering a patient's medical record?

• A. Allowing a patient's brother to view her chart to find out her birthdate and address so that he can mail her a card
• B. Not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing
• C. Not allowing a patient to view her chart because she is behind on her payments
• D. All of the above are legal

Correct answer: B

Rationale: The correct answer is not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing. Physicians have a duty to withhold certain health information from patients if disclosing it could potentially harm the patient. In situations where revealing certain information may have a significantly negative impact on the patient's mental or physical health, healthcare providers have the legal right to withhold that information. Allowing a patient's brother to view her chart for non-medical reasons like sending a card is not a valid legal reason for disclosing patient information. Similarly, refusing access based on financial reasons is not a legal ground for restricting access to a patient's medical record as patient care should not be influenced by financial matters.

3. Tommy R., your 68-year-old patient, is at risk for falls. He has fallen 3 times in the last month. You should keep Tommy's ______________ in order to prevent him from falling again.

• A. bedside rails up at all times
• B. bed in the low position
• C. call bell within reach
• D. family members in the room at all times

Correct answer: C

Rationale: To prevent falls, it is essential to keep the patient's call bell within reach so they can easily call for help when needed. This allows for timely assistance and can prevent falls. While low beds can reduce the severity of injuries in case of a fall, they do not prevent falls from happening. Having family members in the room at all times is not a realistic or practical solution. Side rails can actually increase the severity of falls as patients may attempt to climb over them, and using side rails as fall prevention is considered a restraint practice that can lead to entrapment and other risks.

4. Which of the following is a function of risk management?

• A. To consider the problems that arise if errors happen and their effects on the healthcare environment
• B. To identify how nursing care responds to specific client problems
• C. To view clients as customers and decide what actions will provide a satisfying healthcare experience
• D. To analyze physician-nurse relationships and determine where collaboration efforts can improve

Correct answer: A

Rationale: The function of risk management in healthcare is to assess and address potential risks that could lead to errors and their effects on the healthcare environment. This involves identifying, evaluating, and prioritizing risks to minimize their impact and prevent adverse outcomes. Choice A is correct because it aligns with the core purpose of risk management in healthcare. Choices B, C, and D are incorrect as they do not directly relate to the primary focus of risk management, which is the proactive management of risks to ensure patient safety and quality care.

5. A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical exam?

• A. Start the hepatitis B immunization series.
• B. Teach the patient about hepatitis A immune globulin.
• C. Ask whether the patient has been screened for hepatitis C.
• D. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).

Correct answer: C

Rationale: The correct action for the nurse to include in care when the patient is seen for a routine annual physical exam, according to CDC guidelines, is to ask whether the patient has been screened for hepatitis C. CDC guidelines recommend screening patients born between 1945 and 1965 for hepatitis C due to the high prevalence of undiagnosed cases in this age group. Starting the hepatitis B immunization series is not necessary as the patient already had hepatitis A infection. Teaching the patient about hepatitis A immune globulin is not indicated in this scenario. Testing for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM) is not needed as the patient has already had hepatitis A.

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