Nursing Elites

1. A client with dysphagia is ready to eat lunch. Which of these foods on the tray would be best to start with when assisting the client?

• A. diced fruit
• B. apple juice with a liquid thickener
• C. Jell-O�
• D. toast

Correct answer: B

Rationale: The correct choice is apple juice with a liquid thickener. A client with dysphagia is at risk for aspiration, so it is crucial to start with liquids and assess the client's ability to swallow before introducing solid foods. Using a liquid thickener with apple juice allows the healthcare provider to evaluate swallowing function. Jell-O�, although it melts into a clear liquid, should be avoided initially as it may not provide a clear assessment of swallowing ability. Diced fruit and toast are solid foods that should be introduced only after the client's swallowing ability with liquids has been assessed.

2. The nurse manager of a quality improvement program asks a nurse in the neurological unit to conduct a retrospective audit. Which action should the auditing nurse plan to perform in this type of audit?

• A. Checking the crash cart to ensure that all needed supplies are readily available in case of an emergency
• B. Checking the documentation written by a new nursing graduate on her assigned clients at the end of the shift
• C. Reviewing neurological assessment checklists for all clients on the unit to ensure that these assessments are being conducted as prescribed
• D. Obtaining the assigned medical record from the hospital's medical record room to review documentation made during a client's hospital stay

Correct answer: D

Rationale: Quality improvement, also known as performance improvement, focuses on processes contributing to client safety and care outcomes. Retrospective audits involve reviewing medical records after discharge for compliance with standards. Concurrent audits assess staff compliance during a client's stay. Therefore, obtaining the medical record from the hospital's record room for review is crucial in a retrospective audit. Options A, B, and C are more suited for concurrent audits as they involve real-time assessment during a client's stay.

3. An LPN is caring for a primarily bedridden client. Which finding should be of least concern?

• A. swollen feet
• B. brown discoloration above the ankles
• C. leg pain
• D. capillary refill time of 3 seconds on the big toe

Correct answer: D

Rationale: The correct answer is the capillary refill time of 3 seconds on the big toe. A capillary refill time longer than three seconds may indicate inadequate blood flow. Swollen feet, brown discoloration above the ankles, and leg pain are all signs of venous insufficiency to the lower extremities. These findings can suggest circulation issues and require further assessment and intervention. Therefore, they should be of more concern compared to the capillary refill time of 3 seconds on the big toe, which is within the normal range of 2-3 seconds.

4. Which sign might a healthcare professional observe in a client with a high ammonia level?

• A. coma
• B. edema
• C. hypoxia
• D. polyuria

Correct answer: A

Rationale: A high ammonia level can lead to hepatic encephalopathy, which includes symptoms like confusion, disorientation, and can progress to coma. Coma is a severe condition of unconsciousness. Edema is swelling caused by excess fluid trapped in body tissues, not typically associated with high ammonia levels. Hypoxia is a condition of inadequate oxygen supply to tissues and organs, not directly related to high ammonia levels. Polyuria is excessive urination, which is not a typical sign of high ammonia levels.

5. A case manager is reviewing notations made in clients' records. Which note indicates an unexpected outcome and the need for immediate follow-up?

• A. A client who exhibits signs of increased intracranial pressure after a craniotomy.
• B. A client who has sustained a stroke and dresses herself.
• C. A client with a spinal cord injury transfers himself from a bed to a wheelchair.
• D. Normal neurological findings are noted in a client with a cerebral aneurysm.

Correct answer: A

Rationale: A case manager is responsible for coordinating a client's care and monitoring for unexpected outcomes. The situation that indicates an unexpected outcome and the need for immediate follow-up is when a client exhibits signs of increased intracranial pressure after a craniotomy. This indicates a deteriorating condition that requires urgent intervention. Choices B, C, and D describe expected outcomes or normal findings related to specific conditions, which do not demand immediate follow-up.

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