Nursing Elites

1. A client is going to be admitted for a scheduled surgical procedure. Which action does the nurse explain is the most important thing the client can do to protect against errors?

• A. Bring a list of all medications and their purposes.
• B. Keep the doctor's phone number close by.
• C. Ensure all providers wash their hands before entering the room.
• D. Document the name of each caregiver who enters the room.

Correct answer: A

Rationale: The most important action a client can take to protect against errors is to bring a list of all medications and their purposes. This helps ensure that the healthcare team has accurate information about the client's medications, reducing the risk of medication errors, which are the most common type of healthcare mistake. Knowing the medications and their purposes can also aid in preventing drug interactions and adverse effects during the surgical procedure.

2. A client has a pleural chest tube. Which action should the nurse take to ensure safe use of this equipment?

• A. Never strip the tubing to maintain patency.
• B. Secure tubing junctions with tape to prevent accidental disconnections.
• C. Set wall suction at the level recommended by the device manufacturer.
• D. Keep padded clamps at the bedside for use if the drainage system is interrupted.

Correct answer: D

Rationale: To ensure safe use of a pleural chest tube, the nurse should keep padded clamps at the bedside for use if the drainage system becomes dislodged or is interrupted. Stripping the tubing should never be done to maintain patency. Tubing junctions should be secured with tape, not clamps. Wall suction should be set at the level recommended by the device manufacturer, not the provider.

3. While dining at a restaurant, a person begins to choke. Which of the following actions should the nurse take?

• A. Instruct the person to call 911.
• B. Ask the person if he/she can speak.
• C. Use the jaw-thrust maneuver.
• D. Perform abdominal thrusts.

Correct answer: B

Rationale: When encountering a choking individual, the nurse should first assess the person's ability to speak. If the person can speak, it indicates that their airway is partially obstructed, allowing some air to pass. In this case, encouraging the person to continue coughing and monitoring them closely may be appropriate. If the person cannot speak, it may suggest a complete airway obstruction and immediate intervention is required. Instructing the person to call 911 (Choice A) may be necessary if the situation worsens. Using the jaw-thrust maneuver (Choice C) is not appropriate for a choking victim. Performing abdominal thrusts (Choice D) is typically recommended for conscious choking victims, not chest compressions.

4. When caring for a client with acute renal failure, which laboratory value is most important to monitor?

• A. Serum sodium
• B. Serum potassium
• C. Serum calcium
• D. Serum chloride

Correct answer: B

Rationale: In acute renal failure, monitoring serum potassium is crucial because impaired kidney function can lead to hyperkalemia, which can result in life-threatening cardiac dysrhythmias. Elevated potassium levels need close monitoring and prompt interventions to prevent serious complications.

5. A healthcare provider is assessing a client who had a myocardial infarction. Upon auscultating heart sounds, the provider hears the following sound. What action by the provider is most appropriate?

• A. Assess the client's lung sounds.
• B. Call the Rapid Response Team.
• C. Have the client sit upright.
• D. Listen to the client's lung sounds.

Correct answer: A

Rationale: The sound described is an S3 heart sound, which can indicate heart failure. The next appropriate action for the provider is to listen to the client's lung sounds. Lung sounds can provide additional information about the client's condition, especially when abnormal heart sounds are present. Calling the Rapid Response Team is not warranted based solely on the heart sound assessment. Having the client sit upright is not directly related to addressing the abnormal heart sound.

Similar Questions