Nursing Elites

1. A nurse is performing an end-of-shift count of narcotics kept in the locked cabinet. The narcotic log states there should be 26 oxycodone pills left, but there are only 24 in the drawer. What is the first action of the nurse?

• A. Perform the count again
• B. Contact the pharmacy to determine if the narcotic log is incorrect
• C. Check with the last nurse to sign out narcotics from the system
• D. Notify the house supervisor that narcotic medications are missing

Correct answer: A

Rationale: The first action the nurse should take in this situation is to perform the count again. This step is crucial to ensure there was no miscount during the initial check. By verifying the count, the nurse can confirm if there is indeed a discrepancy in the number of oxycodone pills. Contacting the pharmacy, checking with the last nurse, or notifying the house supervisor should only be considered after ensuring the count is accurate. It's important to rule out any human error before escalating the issue to others.

2. Mr. Y had surgery two days ago and is recovering on the surgical unit of the hospital. Just before lunch, he develops chest pain and difficulties with breathing. His respiratory rate is 32/minute, his temperature is 100.8°F, and he has rales on auscultation. Which of the following nursing interventions is most appropriate in this situation?

• A. Place the client in the Trendelenburg position
• B. Contact the physician for an order for antibiotics
• C. Administer oxygen therapy
• D. Decrease his IV rate

Correct answer: C

Rationale: Chest pain, dyspnea, tachypnea, mild fever, and rales or crackles on auscultation in a client who had surgery 2 days ago may be indicative of a pulmonary embolism. The nurse should administer oxygen to address his breathing and assist him to a comfortable position to facilitate better oxygenation before contacting the physician. Placing the client in the Trendelenburg position is not recommended in this situation as it may worsen a potential pulmonary embolism by increasing venous return. Contacting the physician for antibiotics is not the priority as the immediate concern is addressing the breathing difficulty. Decreasing the IV rate is not indicated in this situation where the client is experiencing respiratory distress and needs oxygen therapy.

3. A writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially, the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign a staff member to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is demanding, arrogant, talks fast, and is hyperactive, setting realistic limits to the client's behavior is essential to ensure safety as manic clients may engage in injurious activities. A quiet environment and consistent, firm limits help to maintain control. While repeating verbal instructions may be necessary due to distractibility, it is not the priority compared to setting limits for safety. Allowing the client to express feelings is important, but only non-destructive methods of expression should be permitted. Assigning a staff member to be with the client at all times is not a realistic approach as it may not always be feasible or necessary for managing manic behavior effectively.

4. The nurse is performing discharge teaching for Mrs. S after cardiac angioplasty. Her husband is present for the teaching. While explaining the prescription for antiplatelet medication to use at home, Mrs. S's husband states, 'I don't think I can afford to refill that medication.' What is the most appropriate response of the nurse?

• A. Don't worry, your insurance will cover it.
• B. I'll ask the physician if he can prescribe a medication that is more affordable.
• C. You should apply for Medicare to see if they can help you.
• D. This medication is essential for her care and should be given priority over all others that she is taking.

Correct answer: B

Rationale: The most appropriate response for the nurse in this situation is to offer assistance in exploring more affordable medication options. It is important to address the patient's concerns about medication costs to ensure adherence to the treatment plan. By suggesting to ask the physician if a more affordable alternative is available, the nurse shows understanding and a commitment to helping the patient access necessary medications. Choice A is incorrect because assuming insurance coverage without verifying can lead to false expectations. Choice C is incorrect as Medicare eligibility and assistance may not be applicable in this scenario. Choice D is incorrect as it does not address the financial concern raised by the husband and emphasizes the importance of the medication without offering a practical solution to affordability.

5. The client with multiple sclerosis is being educated by the nurse on exercises and physical activities. Which statement by the client indicates a need for further teaching?

• A. "I can lift weights and engage in resistance training."?
• B. "I should exercise until I am exhausted."?
• C. "I can incorporate aerobic exercises into my routine."?
• D. "I should perform proper stretching before starting my routine."?

Correct answer: B

Rationale: The correct answer is, "I should exercise until I am exhausted."? This statement indicates a need for further teaching because patients with multiple sclerosis should avoid exercising to the point of exhaustion or fatigue. Strenuous physical activity can increase body temperature and potentially worsen symptoms in individuals with multiple sclerosis. Choice A is correct because lifting weights and resistance training can be appropriate exercises for patients with multiple sclerosis. Choice C is valid because aerobic exercises can also be beneficial. Choice D is accurate as proper stretching before starting an exercise routine is essential for preventing injuries.

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