Nursing Elites

1. A physician has written an order for '2.0 mg MS q 2-4 hr prn pain.' What is the nurse's appropriate response to this order?

• A. Give 2 mg of morphine sulfate to the client
• B. Give 20 mg of morphine sulfate to the client
• C. Contact the pharmacy to clarify the order
• D. Contact the physician to rewrite the order

Correct answer: D

Rationale: The physician's order contains several errors that could lead to potential harm to the client if not addressed. The use of '2.0' involves a trailing decimal point, which may lead to confusion regarding the intended dose of the drug. Additionally, the abbreviation 'MS' is considered a Do Not Use abbreviation by the Joint Commission, as it could refer to morphine sulfate or magnesium sulfate, leading to medication errors. While the order indicates the drug should be used for pain, the nurse should contact the physician to clarify the exact dose and specific drug to be administered, ensuring safe and accurate medication administration. Therefore, the correct response is to contact the physician to rewrite the order.

2. Family members of a patient ask repeated questions about the monitors and various readings in the patient's room. What is the most supportive response to their questions?

• A. Inform them that you can't take the time to answer all their questions
• B. Provide detailed explanations for each device
• C. Tell them it's too technical to explain
• D. Provide an overview and encourage them to spend their time with the patient

Correct answer: D

Rationale: Addressing the family's questions and providing an overview of information validates their concerns and addresses their requests. Limiting details and encouraging them to focus on the patient helps to avoid anxiety that could be created by focusing on values that should be interpreted in the context of the patient's situation by professionals with experience with such data. It also encourages them to provide what they uniquely have to offer: a comforting presence for their loved one. Choice A is dismissive and does not address the family's needs. Choice B may overwhelm the family with unnecessary technical information. Choice C is unhelpful as it disregards the family's genuine interest and concern. Therefore, choice D is the most appropriate response as it balances providing information while guiding the family to focus on supporting the patient.

3. Mr. N is a client who entered the hospital with a diagnosis of diabetic ketoacidosis. The nurse enters his room to check his vital signs and finds him breathing at a rate of 32 times per minute; his respirations are deep and regular. Which type of respiratory pattern is Mr. N most likely exhibiting?

• A. Kussmaul respirations
• B. Cheyne-Stokes respirations
• C. Biot's respirations
• D. Cluster breathing

Correct answer: A

Rationale: Mr. N is most likely exhibiting Kussmaul respirations. Kussmaul respirations are a form of hyperventilation associated with conditions like metabolic acidosis. They are characterized by rapid, regular, and deep breathing. This type of respiratory pattern helps the body compensate for metabolic acidosis by attempting to blow off excess carbon dioxide. This pattern is different from Cheyne-Stokes respirations (choice B), which are characterized by alternating periods of deep, rapid breathing followed by apnea. Biot's respirations (choice C) are characterized by groups of quick, shallow inspirations followed by irregular periods of apnea, and Cluster breathing (choice D) involves clusters of breaths followed by periods of apnea, often seen in patients with brain injury or neurological conditions.

4. The client is receiving an MAOI. Which foods should the nurse caution the client to avoid?

• A. Pork, spinach, and fresh oysters
• B. Milk, grapes, and meat tenderizers
• C. Cheese, beer, and products with chocolate
• D. Leafy green vegetables, fresh apples, and ice cream

Correct answer: C

Rationale: The correct answer is C. When a client is receiving a monoamine oxidase inhibitor (MAOI), they should avoid foods high in tyramine to prevent a hypertensive crisis. Cheese, beer, and products with chocolate are rich in tyramine and can interact with MAOIs, leading to a dangerous rise in blood pressure. Choices A, B, and D do not contain high levels of tyramine and are not typically restricted when taking MAOIs.

5. Which of the following clients is most likely ready to be dismissed from an inpatient care setting to home?

• A. A 65-year old male with urine output of 60cc in the past four hours
• B. A 2-month old female with a temperature of 100.6 rectally
• C. A 38-year old female who transitioned from IV TPN to full liquids six hours ago
• D. A 4-year old male with an oxygen saturation of 96% on room air

Correct answer: D

Rationale: Clients must meet a certain amount of set criteria before they will be discharged from a healthcare facility. Although guidelines may vary between locations, most healthcare facilities expect clients to have adequate oxygenation, nutrition, and elimination; and be free from fever, vomiting, and significant pain

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