Nursing Elites

1. A client has experienced a CVA with right hemiparesis and is ready for discharge from the hospital to a long-term care facility for rehab. To provide optimal continuity of care, the nurse should do all of the following except:

• A. document the current functional status
• B. have the physician fax a report to the receiving facility
• C. copy appropriate parts of the medical record for transport to the receiving facility
• D. phone a report to the facility

Correct answer: B

Rationale: To ensure optimal continuity of care for a client transitioning to a long-term care facility for rehab after a CVA, the nurse plays a crucial role in communication. Documenting the current functional status is essential for the receiving facility to plan appropriate care. Copying relevant parts of the medical record for transport provides important background information. Phoning a report directly to the facility is a direct and effective way to communicate the client's condition and care plan. However, having the physician fax a report to the receiving facility introduces an extra step that may delay essential information transfer and increase the risk of miscommunication. Therefore, it is not the optimal choice for ensuring seamless continuity of care.

2. A nurse monitoring a client with a chest tube notes that there is no tidaling of fluid in the water seal chamber. After further assessment, the nurse suspects that the client's lung has reexpanded and notifies the healthcare provider. The healthcare provider verifies with the use of a chest x-ray that the lung has reexpanded, then calls the nurse to ask that the chest tube be removed. Which action should the nurse take first?

• A. Explain the procedure to the client, then remove the chest tube.
• B. Call the nursing supervisor.
• C. Inform the healthcare provider that removal of a chest tube is not a nursing procedure.
• D. Obtain petrolatum-impregnated gauze and ask another nurse to assist in removing the chest tube.

Correct answer: C

Rationale: The correct action for the nurse to take first is to inform the healthcare provider that removal of a chest tube is not a nursing procedure. Actual removal of a chest tube is the duty of a healthcare provider. If the healthcare provider insists that the nurse remove the tube, the nurse must contact the nursing supervisor. Some agencies' policies and procedures may permit an advanced practice nurse to remove a chest tube, but there is no information in the question to indicate that the nurse is an advanced practice nurse. Choice A is incorrect because the nurse should not proceed with removing the chest tube without proper authorization. Choice B is incorrect as calling the nursing supervisor should come after clarifying with the healthcare provider. Choice D is incorrect as the nurse should not begin the process of removing the chest tube without proper guidance and authorization.

3. What is the role of the incident report in risk management?

• A. Liability protection.
• B. To provide data for analysis by a risk manager to determine how future problems can be avoided.
• C. To discipline staff for errors.
• D. All of the above.

Correct answer: B

Rationale: The correct answer is 'To provide data for analysis by a risk manager to determine how future problems can be avoided.' Incident reports are a crucial tool for collecting information about incidents to analyze them and prevent similar issues in the future. They are not primarily used for liability protection or disciplining staff. Therefore, choices A and C are incorrect. Selecting 'All of the above' (choice D) is not accurate as incident reports serve a specific purpose related to data analysis and risk prevention, excluding liability protection and staff discipline.

4. A client is diagnosed with HIV. Which of the following antiviral drug classes are used in the treatment of HIV/AIDS?

• A. nucleoside reverse transcriptase inhibitors
• B. protease inhibitors
• C. HIV fusion inhibitors
• D. all of the above

Correct answer: D

Rationale: All of the provided choices are antiviral drug classes used in the treatment of HIV/AIDS. Nucleoside reverse transcriptase inhibitors, such as tenofovir and emtricitabine, work by interfering with the virus's ability to replicate. Protease inhibitors, like atazanavir and darunavir, block an enzyme that HIV needs to make copies of itself. HIV fusion inhibitors, for instance, enfuvirtide, prevent HIV from entering human cells. Therefore, 'all of the above' is the correct answer as all the listed drug classes are commonly used in managing HIV infections. Choices A, B, and C are all essential components of antiretroviral therapy for HIV, targeting different stages of the virus's life cycle. The combination of drugs from these classes is often recommended to effectively control HIV replication and reduce viral load.

5. A client with a left arm fracture complains of severe diffuse pain that is unrelieved by pain medication. On further assessment, the nurse notes that the client experiences increased pain during passive motion compared with active motion of the left arm. Based on these assessment findings, which action should the nurse take first?

• A. Contacting the health care provider
• B. Checking if it is time for more pain medication
• C. Encouraging the client to continue active range of motion exercises of the left arm
• D. Repositioning the client for comfort

Correct answer: A

Rationale: The correct answer is to contact the health care provider. The client with early acute compartment syndrome typically complains of severe diffuse pain that is unrelieved by pain medication. Additionally, the affected client experiences greater pain during passive motion compared to active motion. In this situation, it is crucial to notify the health care provider immediately for further evaluation and intervention. Contacting the health care provider is essential to ensure timely diagnosis and appropriate management of the condition. Checking for more pain medication, encouraging active range of motion exercises, or repositioning the client may not address the underlying issue of acute compartment syndrome and could delay necessary interventions. Therefore, the priority action should be to involve the healthcare provider for prompt assessment and treatment.

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