Nursing Elites

1. A nurse is caring for a client who has an indwelling urinary catheter. Which of the following findings indicates that the catheter requires irrigation?

• A. Urine is positive for ketones
• B. Urine has an unusual odor
• C. Urine specific gravity is 1.035 (normal range: 1.010 to 1.025)
• D. Bladder scan shows 525 mL of urine

Correct answer: A

Rationale: The correct answer is A. Ketones in the urine may indicate infection or blockage in the urinary catheter, necessitating irrigation to ensure proper drainage. Choice B, an unusual odor in the urine, may suggest infection but does not directly indicate the need for catheter irrigation. Choice C, a high urine specific gravity, is indicative of concentrated urine but does not specifically point to the need for catheter irrigation. Choice D, a bladder scan showing 525 mL of urine, indicates urine retention, which may require catheterization or further assessment but not necessarily irrigation.

2. Which of the following is a key component of a successful quality improvement (QI) project?

• A. Standardized care protocols
• B. Employee satisfaction
• C. Ongoing training and education
• D. Financial incentives

Correct answer: C

Rationale: Ongoing training and education is the correct answer as it is an essential component of a successful quality improvement project. Continuous training and education help ensure that staff are knowledgeable about and up-to-date with the latest practices, technologies, and methodologies in healthcare. This ongoing learning process contributes to improving the quality of care provided.\nChoice A, standardized care protocols, though important, is more about ensuring consistency in care delivery rather than driving quality improvement initiatives. Choice B, employee satisfaction, while significant for staff morale, is not directly related to the core processes of quality improvement projects. Choice D, financial incentives, although motivating, are not the primary driver for successful quality improvement projects; it is the knowledge and skills gained through training and education that play a more critical role in enhancing quality.

3. Which patient action indicates a good understanding of the nurse�s teaching about the use of an insulin pump?

• A. The patient programs the pump for an insulin bolus after eating
• B. The patient changes the location of the insertion site every week
• C. The patient takes the pump off at bedtime and starts it again each morning.
• D. The patient plans for a diet that is less flexible when using the insulin pump.

Correct answer: A

Rationale:

4. A recent ethical issue has resulted in uneasiness and discomfort for several nurses on a unit. The unit manager has decided to discuss the issues at the next team meeting. The situation has resulted in which of the following for some of the nurses?

• A. Moral suffering
• B. Moral distress
• C. Ethical dilemma
• D. Veracity

Correct answer: B

Rationale: The correct answer is B, moral distress. Moral distress occurs when one knows the ethically correct action to take but feels constrained in their ability to take that action due to institutional, hierarchical, or other constraints. In this scenario, the nurses are experiencing uneasiness and discomfort due to an ethical issue, which aligns with the definition of moral distress. Choice A, moral suffering, is not the most appropriate term in this context as moral distress better describes the situation. Choice C, ethical dilemma, refers to a situation where a person is faced with two equally undesirable alternatives, which does not fully capture the nurses' current experience. Choice D, veracity, is unrelated to the nurses' situation and does not fit the context of the scenario.

5. What should the nurse do after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

• A. Assess the patient for symptoms of hyperglycemia.
• B. Give the patient a snack of peanut butter and crackers.
• C. Have the patient drink a glass of orange juice or nonfat milk.
• D. Administer a continuous infusion of 5% dextrose for 24 hours.

Correct answer: B

Rationale: After a patient treated with intramuscular glucagon for hypoglycemia regains consciousness, providing a snack of peanut butter and crackers is essential to prevent another episode of hypoglycemia. Peanut butter and crackers contain a combination of protein and carbohydrates, which can help stabilize the patient's blood glucose levels. This choice is the most appropriate immediate action to prevent recurrence of hypoglycemia in this scenario. Assessing for symptoms of hyperglycemia (choice A) is not the immediate priority after treating hypoglycemia. While orange juice or nonfat milk (choice C) can help raise blood sugar, they lack the sustained effect of protein found in peanut butter. Administering a continuous infusion of dextrose (choice D) is excessive and not indicated after the patient has already regained consciousness.

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