Nursing Elites

1. Activities of effective supervisors can be task-related or people-related activities. An example of a task-related supervisory activity is:

• A. coaching.
• B. evaluating.
• C. delegating.
• D. facilitating.

Correct answer: delegating.

Rationale: Delegating is the act of assigning work to those capable and competent to do the work, making it a task-related supervisory activity. Coaching, evaluating, and facilitating are people-related supervisory activities. Coaching involves guiding and developing individuals, evaluating entails assessing performance, and facilitating focuses on enabling tasks and processes. These activities are more centered on interacting with and supporting people rather than directly assigning tasks. Therefore, in the context of task-related activities, delegating stands out as the correct choice.

2. A 10-month-old child is brought to the Emergency Department because he is difficult to awaken. The nurse notes bruises on both upper arms. These findings are most consistent with

• A. wearing clothing that is too small for the child
• B. the child being shaken
• C. falling while learning to walk
• D. parents trying to awaken the child

Correct answer: the child being shaken

Rationale: The correct answer is 'the child being shaken.' Children who are shaken are frequently grasped by both upper arms, leading to bruises in that area. The presentation of a difficult-to-awaken child with bruises on the upper arms is highly concerning for non-accidental trauma, such as abusive shaking. Symptoms of brain injury associated with shaking include a decreased level of consciousness. Choices A, C, and D are less likely because the combination of a child being difficult to awaken and bruises on both upper arms is highly suggestive of non-accidental trauma rather than benign causes like ill-fitting clothing, falling while learning to walk, or parents trying to awaken the child.

3. In the emergency room, a nurse is responsible for triaging four clients injured in a motor vehicle accident. Which of the following clients should receive priority in care?

• A. A 10-year-old with lacerations on the face
• B. A 15-year-old with sternal bruises
• C. A 34-year-old with a fractured femur
• D. A 50-year-old with a dislocated elbow

Correct answer: B: A 15-year-old with sternal bruises

Rationale: The 15-year-old with sternal bruises should receive priority in care as this client might be experiencing airway and oxygenation problems. Airway issues take precedence in triage. The 10-year-old with lacerations on the face, although looking bad, is not in immediate distress. The 34-year-old with a fractured femur should be immobilized but can be seen after the client with sternal bruising. The 50-year-old with a dislocated elbow can also be seen later as dislocated elbows are not life-threatening compared to potential airway compromise.

4. A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:

• A. naloxone (Narcan)
• B. labetalol (Normodyne)
• C. neostigmine (Prostigmin)
• D. thiothixene (Navane)

Correct answer: naloxone (Narcan)

Rationale: The correct answer is naloxone (Narcan). Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression and somnolence. In this scenario, the client's extreme somnolence and respiratory depression suggest an opioid overdose, making naloxone the appropriate choice to counteract these effects. Labetalol (Normodyne) is a nonselective beta-blocker used to treat hypertension, not opioid overdose. Neostigmine (Prostigmin) is a cholinesterase inhibitor used to reverse neuromuscular blockade, not opioid-induced respiratory depression. Thiothixene (Navane) is an antipsychotic medication used to treat schizophrenia and is not indicated for opioid overdose.

5. A 57-year-old woman is recently widowed. She states, “I will never be able to learn how to manage the finances. My husband did all of that.” Select the nurse’s response that could help raise the client’s self-esteem.

• A. “You feel inadequate because you have never learned to balance a checkbook.”
• B. “You should have insisted your husband teach you about the finances.”
• C. “You are strong and will learn how to manage your finances after a while.”
• D. “I believe in your strength to learn how to manage your finances in time.”

Correct answer: “You are strong and will learn how to manage your finances after a while.”

Rationale: The nurse should aim to boost the client's self-esteem by providing positive reinforcement. By stating, “You are strong and will learn how to manage your finances after a while,” the nurse acknowledges the client's strength and capability, encouraging her to believe in herself. Choice A is incorrect as it focuses on the client's inadequacy rather than empowering her. Choice B places unnecessary blame on the client for not taking action in the past. Choice D, though positive, slightly alters the nurse's original phrase, making choice C the most appropriate response to uplift the client's self-esteem.

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