Nursing Elites

1. A 12-year-old client who had an appendectomy two days ago is receiving 0.9% normal saline at 50 ml/hour. The client’s urine specific gravity is 1.035. What action should the nurse implement?

• A. Encourage popsicles and fluids of choice
• B. Evaluate postural blood pressure measurements
• C. Obtain a specimen for urinalysis
• D. Assess bowel sounds in all quadrants

Correct answer: A

Rationale: Encouraging fluids helps address dehydration and potentially high urine specific gravity, which is often related to inadequate fluid intake. In this scenario, the client may be at risk of dehydration due to the appendectomy and the high urine specific gravity. Encouraging popsicles and fluids of choice can help increase fluid intake and improve hydration status. The other options are not the priority at this time. Postural blood pressure measurements may be relevant for assessing fluid status but are not the immediate action needed. Obtaining a specimen for urinalysis and assessing bowel sounds are not the priority actions based on the client's condition.

2. A female client on the mental health unit frequently asks the nurse when she can be discharged. Then, becoming more anxious, she begins to pace the hallway. What intervention should the nurse implement first?

• A. Review the current treatment plan with the client
• B. Inform the healthcare provider about the client’s behaviors
• C. Determine if the client has PRN medication for anxiety
• D. Explore the client’s reasons for wanting to be discharged

Correct answer: D

Rationale: Exploring the client’s reasons for wanting to be discharged should be the first intervention as it helps to address underlying anxieties and concerns. By understanding the client's motivations, the nurse can provide appropriate support and interventions. It can also reduce distress and improve the therapeutic relationship. Reviewing the treatment plan (Choice A) may be important but addressing the immediate distress takes precedence. Informing the healthcare provider (Choice B) can be considered later if necessary. Determining if the client has PRN medication (Choice C) is relevant, but exploring the underlying reasons for the desire to be discharged is more beneficial in this situation.

3. When deciding whether to join a nursing strike called after collective bargaining efforts have failed, which factor is most important for the nurse to consider?

• A. Nurse Practice Act of the State
• B. The role of nurses as client advocates
• C. Standards of clinical nursing practice
• D. Personal value system

Correct answer: B

Rationale: The correct answer is B. The role of nurses as client advocates is crucial when considering the impact of a strike on patient care. Nurses have a responsibility to advocate for their patients' well-being at all times. Choices A, C, and D, although important, are not the most critical factor to consider in this situation. The Nurse Practice Act of the State is essential for guiding nursing practice, standards of clinical nursing practice ensure quality care, and personal values are important; however, the primary focus during a strike should be on the role of nurses as client advocates.

4. A continuous infusion of nitroglycerin is prescribed for an adult male admitted with an acute myocardial infarction. The client is experiencing active chest pain that he describes as 8 out of 10. Which intervention is most important for the nurse to implement?

• A. Administer the infusion via an infusion pump
• B. Obtain the current serum potassium level
• C. Continuously monitor blood pressure
• D. Teach guided imagery to decrease pain

Correct answer: C

Rationale: Continuously monitoring blood pressure is crucial in this case because nitroglycerin can cause hypotension as a side effect. Monitoring blood pressure allows the nurse to assess the client's response to the medication and detect any signs of hypotension promptly. This intervention is essential to ensure the effectiveness of nitroglycerin therapy and prevent potential complications. Administering the infusion via an infusion pump is important for accurate dosing but not the most critical at this moment. Obtaining the current serum potassium level is important but not the most immediate concern when the client is experiencing active chest pain. Teaching guided imagery may be beneficial for pain management, but in this scenario, monitoring blood pressure takes precedence due to the potential side effects of nitroglycerin.

5. After completion of mandatory counseling, the impaired nurse has asked nursing administration to allow return to work. When the nurse administrator approaches the charge nurse with the impaired nurse’s request, what action is best for the charge nurse to take?

• A. Ask to meet with the impaired nurse’s therapist before allowing the nurse back on the unit
• B. Meet with staff to assess their feelings about the impaired nurse’s return to the unit
• C. Since treatment is completed, assign the nurse to routine RN responsibilities
• D. Allow the impaired nurse to return to work and monitor medication administration

Correct answer: D

Rationale: Allowing the impaired nurse to return to work with monitoring is the best course of action in this scenario. By monitoring the impaired nurse's medication administration, the charge nurse can ensure safe practice while supporting the nurse's reintegration into the work environment. Meeting with the therapist (Choice A) is not within the charge nurse's scope of responsibility and may violate the impaired nurse's privacy. Assessing staff feelings (Choice B) is important but should be done by leadership, not the charge nurse. Simply assigning routine duties (Choice C) may not address the need for monitoring and support required in this situation.

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