Nursing Elites

1. A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, the nurse was found asleep in a chair in the break room not during a break time. Which of the following actions should the nurse take?

• A. Alert the American Nurses Association.
• B. Fill out an incident report.
• C. Report the observations to the nurse manager on the unit.
• D. Leave the nurse alone to sleep.

Correct answer: C

Rationale: Reporting the observations to the nurse manager is the appropriate action to ensure the safety of the clients and address potential impairment. The nurse manager can take necessary steps to assess the situation and intervene if needed. Alerting the American Nurses Association (Choice A) is not necessary at this stage as the immediate concern is the safety of clients in the unit. Filling out an incident report (Choice B) may be required later, but the priority is to address the issue promptly by involving the immediate supervisor. Leaving the nurse alone to sleep (Choice D) is not a safe option as it does not address the underlying problem of potential impairment and safety concerns; it is essential to address the issue promptly to ensure patient safety.

2. A nurse on a medical-surgical unit is admitting a client. Which of the following information should the nurse document in the client's record first?

• A. Assessment
• B. Plan of care
• C. Client history
• D. Medication list

Correct answer: A

Rationale: The correct answer is A: Assessment. When admitting a client, the nurse should document assessment data first. This information is crucial as it provides a baseline for planning care and treatment. By documenting the assessment initially, the nurse can accurately identify the client's needs and prioritize care. Choice B, Plan of care, would be developed based on the assessment findings, so it should come after the initial assessment. Choices C and D, Client history and Medication list, are important but would typically be documented after the assessment to ensure that the most current and relevant information is captured in the client's record.

3. A charge nurse is observing a newly licensed nurse perform tracheostomy care for a client. Which of the following actions by the newly licensed nurse requires intervention?

• A. Obtaining cotton balls for the tracheostomy care
• B. Using a sterile water bottle
• C. Checking the suction equipment
• D. Wearing a sterile gown

Correct answer: A

Rationale: The correct answer is A. Obtaining cotton balls for tracheostomy care is not recommended due to the risk of fiber contamination. Sterile gauze should be used instead. Choice B, using a sterile water bottle, is a correct and appropriate action for tracheostomy care to maintain cleanliness. Choice C, checking the suction equipment, is also a necessary step to ensure it is functioning properly for the procedure. Choice D, wearing a sterile gown, is a standard precaution to maintain a sterile environment during tracheostomy care.

4. A nurse at an assisted living facility is preparing an in-service for residents about electrical safety. Which of the following instructions should the nurse include?

• A. Avoid taping electrical cords to the floor.
• B. Clean electrical equipment before disconnection.
• C. Cover exposed wires with tape before use.
• D. Disconnect electrical equipment by grasping the plug.

Correct answer: A

Rationale: The correct instruction for electrical safety is to avoid taping electrical cords to the floor. Taping cords can create tripping hazards, leading to falls and potential injuries. Choice B, cleaning electrical equipment before disconnection, is not directly related to electrical safety but rather to equipment maintenance. Choice C, covering exposed wires with tape before use, is incorrect as exposed wires should be properly insulated and repaired by a qualified professional. Choice D, disconnecting electrical equipment by grasping the plug, is unsafe and can lead to electrical shocks. It is always recommended to unplug devices by holding the plug itself, not by pulling the cord.

5. A client who requires maximal support is being taught how to use a two-wheeled walker by a nurse. Which of the following actions by the client indicates an understanding of the teaching?

• A. The client moves the walker ahead 25.4 cm with each step
• B. The client picks up the walker with each step
• C. The client stands with elbows slightly bent while holding the walker
• D. The client stoops slightly forward when moving the walker

Correct answer: C

Rationale: The correct answer is C. When using a two-wheeled walker, the client should stand with elbows slightly bent to maintain balance and stability. This position helps distribute weight effectively and promotes proper use of the walker. Choices A, B, and D are incorrect. Choice A does not demonstrate proper posture while using the walker. Choice B of picking up the walker with each step is not the correct technique and can lead to instability. Choice D of stooping slightly forward is also incorrect as it can affect balance and posture negatively.

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