Nursing Elites

1. During a physical assessment of adult clients, which of the following techniques should the nurse use?

• A. Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale for a client experiencing pain.
• B. Palpate the client's abdomen before auscultating bowel sounds.
• C. Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
• D. Obtain an apical heart rate by auscultating at the third intercostal space to the left of the sternum.

Correct answer: B

Rationale: When performing a physical assessment, it is essential to palpate the client's abdomen before auscultating bowel sounds. This sequence helps prevent altering bowel sound results due to the pressure applied during palpation. Choice A is incorrect because the FLACC pain rating scale is typically used for nonverbal or pediatric clients, not adults. Choice C is incorrect because the bladder of the blood pressure cuff should surround about 80% of the client's arm circumference, not the bladder of the cuff itself. Choice D is incorrect because to obtain an apical heart rate, auscultation should be done at the fifth intercostal space at the midclavicular line, not at the third intercostal space to the left of the sternum.

2. Which of the following best describes decertification?

• A. Encourage union affiliation
• B. Change union affiliation
• C. Reward union affiliation
• D. Empower union affiliation

Correct answer: B

Rationale: Decertification is the process of removing or changing union affiliation. Choosing option B, 'Change union affiliation,' correctly reflects this definition. Option A, 'Encourage union affiliation,' is incorrect as decertification is not about promoting union membership but rather altering it. Option C, 'Reward union affiliation,' is incorrect as decertification does not involve rewarding union membership. Option D, 'Empower union affiliation,' is incorrect as decertification does not empower union membership but rather modifies or eliminates it.

3. The nurse manager can use several strategies to improve communication when giving directions. Asking the subordinate to repeat the instructions would be which of the following strategies?

• A. Verifying through feedback
• B. Follow-up communication
• C. Getting positive attention
• D. Knowing the context of the instruction

Correct answer: A

Rationale: Asking the subordinate to repeat the instructions is a strategy known as verifying through feedback. This approach ensures that the receiver has understood the request correctly. Choice B, 'Follow-up communication,' refers to checking in after the initial communication, not necessarily asking for repetition. Choice C, 'Getting positive attention,' is unrelated to confirming understanding. Choice D, 'Knowing the context of the instruction,' deals with understanding the background or reasons behind the instructions, not confirming comprehension.

4. Organizations are made up of intertwined links and diversified choices that generate unanticipated consequences. This defines which of the following theories?

• A. Contingency theory
• B. Closed system theory
• C. Open system theory
• D. Chaos theory

Correct answer: D

Rationale: The correct answer is D, Chaos theory. Chaos theory is characterized by organizations that are made up of intertwined links and diversified choices that generate unanticipated consequences. Contingency theory (choice A) is based on the idea that there is no one best way to organize and manage a corporation. Closed system theory (choice B) refers to systems that are closed off from the outside environment and do not interact with it. Open system theory (choice C) views organizations as open systems that interact with their external environment.

5. A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

• A. Infuse 1 liter of normal saline per hour.
• B. Give sodium bicarbonate 50 mEq IV push.
• C. Administer regular insulin 10 U by IV push.
• D. Start a regular insulin infusion at 0.1 units/kg/hr.

Correct answer: A

Rationale: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.

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