Nursing Elites

1. A nurse is administering medications to a group of clients. Which of the following occurrences requires the completion of an incident report?

• A. A client receives his antibiotics 2 hours late.
• B. A client vomits within 20 minutes of taking his morning medications.
• C. A client requests his statin to be administered at 2100.
• D. A client asks for pain medication 1 hour early.

Correct answer: A

Rationale: The correct answer is A. When a client receives antibiotics 2 hours late, it constitutes a medication error, requiring the completion of an incident report. Choice B, a client vomiting within 20 minutes of taking medications, does not necessarily require an incident report unless it is suspected to be related to a medication error. Choice C, a client requesting a statin at a specific time, and choice D, a client asking for pain medication an hour early, are not incidents that mandate the completion of an incident report unless there are specific circumstances indicating otherwise.

2. What is the appropriate nursing response when a patient refuses blood transfusion due to religious beliefs?

• A. Respect the patient's decision and notify the provider
• B. Attempt to persuade the patient to accept the transfusion
• C. Document the refusal and notify the healthcare provider
• D. Provide education on the benefits of blood transfusion

Correct answer: A

Rationale: The correct answer is A: "Respect the patient's decision and notify the provider." When a patient refuses a blood transfusion due to religious beliefs, it is essential to respect their autonomy and religious beliefs. Attempting to persuade the patient (Choice B) goes against the principle of respect for autonomy and can lead to ethical dilemmas. Documenting the refusal and notifying the healthcare provider (Choice C) is important for legal and ethical purposes but should be preceded by respecting the patient's decision. Providing education on the benefits of blood transfusion (Choice D) may be appropriate in other situations but is not indicated when a patient refuses based on religious beliefs.

3. A nurse is providing discharge teaching to a client who has a new diagnosis of diabetes mellitus. Which of the following client statements indicates a need for further teaching?

• A. I will check my blood glucose level once a week.
• B. I will eat a snack if my blood glucose level is above 200 mg/dL.
• C. I will take my insulin as prescribed, even when I am feeling well.
• D. I will avoid physical activity if my blood glucose level is below 100 mg/dL.

Correct answer: B

Rationale: The correct answer is B. Clients should eat a snack when their blood glucose level is low, typically below 70-100 mg/dL, not when it is high. Eating a snack when the blood glucose level is above 200 mg/dL can exacerbate hyperglycemia. Choice A is correct as checking blood glucose levels regularly is important in managing diabetes. Choice C is also correct as adherence to prescribed insulin therapy is crucial. Choice D is incorrect as physical activity can help lower blood glucose levels, especially when they are above the target range.

4. A nurse is caring for a client who has a prescription for digoxin. Which of the following laboratory values should the nurse monitor to identify an adverse effect of this medication?

• A. Potassium 3.5 mEq/L
• B. Sodium 140 mEq/L
• C. Calcium 9.5 mg/dL
• D. Magnesium 2.0 mEq/L

Correct answer: A

Rationale: The correct answer is A: Potassium 3.5 mEq/L. Digoxin can cause hypokalemia as an adverse effect. Monitoring potassium levels is crucial because low potassium levels can increase the risk of digoxin toxicity. Choices B, C, and D are incorrect as they are not directly associated with potential adverse effects of digoxin. Sodium levels are not typically affected by digoxin, calcium levels are not a primary concern with digoxin therapy, and magnesium levels are not the most important to monitor for digoxin adverse effects.

5. A nurse is reviewing the results of an arterial blood gas analysis of a client who has chronic obstructive pulmonary disease. Which of the following results should the nurse expect?

• A. PaO2 of 95 mm Hg
• B. PaCO2 of 55 mm Hg
• C. HCO3 of 24 mEq/L
• D. pH level of 7.35

Correct answer: B

Rationale: In chronic obstructive pulmonary disease, there is impaired gas exchange, leading to retention of carbon dioxide (CO2) and subsequent respiratory acidosis. A PaCO2 of 55 mm Hg is higher than the normal range (35-45 mm Hg) and is indicative of respiratory acidosis in COPD. Choices A, C, and D are not typically associated with COPD. PaO2 may be decreased, HCO3 may be elevated to compensate for acidosis, and pH may be lower than 7.35 due to respiratory acidosis in COPD.

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