Nursing Elites

1. While assisting a healthcare provider in assessing a hospitalized client, the healthcare provider is paged to report to the recovery room. The healthcare provider instructs the nurse verbally to change the solution and rate of the intravenous (IV) fluid being administered. What is the most appropriate nursing action in this situation?

• A. Calling the nursing supervisor to obtain permission to accept the verbal prescription
• B. Asking the healthcare provider to write the prescription in the client's record before leaving the nursing unit
• C. Telling the healthcare provider that the prescription will not be implemented until it is documented in the client's record
• D. Changing the solution and rate of the IV fluid per the healthcare provider's verbal prescription

Correct answer: B

Rationale: Verbal prescriptions should be avoided due to the risk of errors. If a verbal prescription is necessary, it should be promptly written and signed by the healthcare provider, typically within 24 hours. Following agency policies and procedures regarding verbal prescriptions is crucial. In this scenario, the most appropriate nursing action is to request the healthcare provider to document the prescription in the client's record before leaving the unit. Calling the nursing supervisor to accept the verbal prescription without documentation, telling the healthcare provider to delay treatment until documented, and directly changing the IV fluid based on verbal orders all pose risks and do not align with best practices in medication administration.

2. A case management clinical pathway for congestive heart failure might include all of the following except:

• A. physician follow-up appointments with transportation
• B. client education regarding medication use
• C. a nutritional consult for diet review and accommodation
• D. insurance review for reimbursement

Correct answer: D

Rationale: In a case management clinical pathway for congestive heart failure, the focus is on providing medical care and support to the patient. Choices A, B, and C are integral parts of managing congestive heart failure. Physician follow-up appointments with transportation ensure continuity of care, client education about medication use is crucial for adherence, and a nutritional consult helps in managing the patient's diet. However, insurance review for reimbursement is not typically part of the clinical pathway as it pertains to financial aspects and is usually handled by billing departments or external agencies. Therefore, the correct answer is 'insurance review for reimbursement.'

3. An example of a process standard on a med-surg unit is:

• A. a procedure for changing IV tubing.
• B. a policy for staffing.
• C. the job description of the CEO (chief executive officer).
• D. a procedure for checking waveforms on a client being treated with an intra-aortic balloon pump.

Correct answer: D

Rationale: Process standards define the actions and behaviors required by staff to provide care on a med-surg unit. A procedure for changing IV tubing is a critical psychomotor skill necessary for safe and effective patient care in this setting. Choice B, a policy for staffing, pertains more to organizational management rather than specific care processes on the unit. Choice C, the job description of the CEO, delineates the responsibilities of the organization's top executive and is not a process standard for frontline staff. Choice D, a procedure for checking waveforms on a client with an intra-aortic balloon pump, is more specific to a cardiac care unit and not typically performed on a med-surg unit.

4. A nurse is assisting with data collection of a client who has sustained circumferential burns of both legs. What should the nurse examine first?

• A. Heart rate
• B. Peripheral pulses
• C. Blood pressure (BP)
• D. Radial pulse rate

Correct answer: B

Rationale: The priority assessment for a client with circumferential burns to the legs is to examine peripheral pulses. This is essential to ensure adequate circulation to the extremities. Circumferential burns can lead to compartment syndrome, causing decreased circulation to the affected limbs. Checking peripheral pulses is crucial to monitor for any signs of compromised circulation. While heart rate and blood pressure are important assessments in general, in the context of circumferential burns, the immediate concern is the risk of impaired circulation to the extremities. Therefore, assessing peripheral pulses takes precedence in this situation.

5. Delegation of tasks to appropriate personnel allows the nurse to:

• A. ensure tasks are appropriately distributed.
• B. keep other members of the team productive.
• C. maintain tight control of all aspects of the workflow.
• D. recognize the importance of team members' roles.

Correct answer: B

Rationale: Delegating tasks to appropriate personnel is essential for a nurse to keep other team members productive. By assigning tasks that align with the specific roles and responsibilities of team members, the nurse can enhance work effectiveness and efficiency. Option A is incorrect because delegation is not primarily about ensuring tasks are evenly distributed but rather about utilizing team members' skills effectively. Option C is incorrect as maintaining tight control of all aspects of the workflow can hinder teamwork and limit individual growth. Option D is incorrect because effective delegation involves empowering team members to make decisions within their scope of practice, rather than solely recognizing the importance of their roles.

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