Nursing Elites

1. A client with major head trauma is receiving bolus enteral feeding. The most important nursing order for this client is:

• A. measure intake and output.
• B. check albumin levels.
• C. monitor glucose levels.
• D. increase enteral feeding.

Correct answer: A

Rationale: The correct action for a client with major head trauma receiving bolus enteral feeding is to measure intake and output (I&O). Enteral feedings are hyperosmotic agents that can cause fluid shifts. Monitoring I&O is crucial to assess fluid balance, ensuring that input matches output. Checking albumin levels (choice B) is important for assessing nutritional status but is not the immediate priority in this situation. Monitoring glucose levels (choice C) is also important but not as critical as measuring I&O in this context. Increasing enteral feeding (choice D) should only be done based on a healthcare provider's order after assessing the patient's condition, not as the most important nursing order at this time.

2. Quality is defined as a combination of all of the following except:

• A. conforming to standards.
• B. performing at the minimally acceptable level.
• C. meeting or exceeding customer requirements.
• D. exceeding customer expectations.

Correct answer: B

Rationale: Quality in any context is about meeting or exceeding customer requirements and exceeding customer expectations. It also involves conforming to standards to ensure consistency and reliability. Merely performing at the minimally acceptable level does not encompass the essence of quality, as it sets the bar at the lowest level of acceptability rather than aiming for excellence or customer satisfaction. Therefore, the correct answer is 'performing at the minimally acceptable level,' as this choice falls short in capturing the comprehensive definition of quality.

3. Which of the following is responsible for laws mandating the reporting of certain infections and diseases?

• A. Centers for Disease Control and Prevention (CDC)
• B. individual state laws
• C. National Institutes of Health (NIH)
• D. Health and Human Services (HHS)

Correct answer: B

Rationale: Individual state laws mandate the reporting of infectious diseases. The list of reportable diseases varies from state to state and is overseen by state health departments. While the CDC plays a significant role in disease surveillance, reporting infectious diseases is primarily governed by individual state laws. The CDC's role is to provide support, guidance, and expertise to state health departments. The National Institutes of Health (NIH) primarily focus on biomedical and health-related research, not on mandating disease reporting. Health and Human Services (HHS) is a federal department that oversees various agencies, but the responsibility for mandating disease reporting lies with individual states.

4. After securing the client's safety from a faulty electric bed, what should the nurse do next?

• A. Discuss the matter with the client's significant others.
• B. Document the incident in the client's record in detail.
• C. Notify the physician.
• D. Prepare an incident report.

Correct answer: D

Rationale: After ensuring the client's safety from the faulty electric bed, the nurse should prioritize preparing an incident report. This report documents the details of what happened and is crucial for quality improvement and risk management. Choice A, discussing the matter with the client's significant others, may be important in some cases but is not the immediate priority after a safety incident. Choice B, documenting the incident in the client's record, is necessary but should be preceded by preparing an incident report. Choice C, notifying the physician, is important but not as urgent as preparing the incident report to ensure timely reporting and investigation of the safety issue.

5. At what point in the nurse-client relationship should termination first be addressed?

• A. in the working phase
• B. in the termination phase
• C. in the orientation phase
• D. when the client initially brings up the topic

Correct answer: C

Rationale: Termination in the nurse-client relationship should first be addressed in the orientation phase. This is because the client has a right to know the parameters of the relationship from the beginning. During the orientation phase, it is important to discuss if the relationship is time-limited, inform the client about the number of sessions, or explain that it is open-ended with the termination date to be negotiated later. Addressing termination in the orientation phase helps establish transparency and clear communication. Choices A, B, and D are incorrect because termination discussions should ideally start at the beginning of the relationship to set appropriate expectations.

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