Nursing Elites

1. A nurse is caring for a client who is postoperative and is exhibiting signs of hemorrhagic shock. The nurse notifies the surgeon, who tells the nurse to continue to measure the client's vital signs every 15 min and to report back in 1 hour. Which of the following actions should the nurse take next?

• A. Document the surgeon's instructions in the client's medical record.
• B. Complete an incident report.
• C. Consult the charge nurse.
• D. Notify the nursing manager.

Correct answer: D

Rationale: In this scenario, the nurse should notify the nursing manager next. The surgeon's instructions are related to the client's condition, and it is crucial to inform the nursing manager about the situation. Option A is incorrect because documenting the surgeon's instructions in the medical record is not the immediate next step. Option B is also incorrect as completing an incident report is not warranted in this situation. Option C is not the best choice as consulting the charge nurse may cause a delay in escalating the situation to higher management, which is necessary in cases of emergency like hemorrhagic shock.

2. A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to

• A. save the lunch tray for the patient’s later return to the unit
• B. ask that diagnostic testing area staff to start a 5% dextrose IV
• C. send a glass of milk or orange juice to the patient in the diagnostic testing area
• D. request that if testing is further delayed, the patient be returned to the unit to eat.

Correct answer: D

Rationale:

3. What is the term for working on a schedule within the unit, involving only those who are working within that unit?

• A. Flexible staffing
• B. Self-staffing
• C. Internal pools
• D. Management scheduling

Correct answer: B

Rationale: The correct answer is B, self-staffing. Self-staffing is the model where staff entirely manage staffing and scheduling themselves, without external involvement. Choices A, C, and D are incorrect. Flexible staffing refers to adjusting staffing levels based on demand. Internal pools involve a group of staff who can be drawn upon for scheduling needs. Management scheduling typically involves supervisors or managers creating and managing schedules for the unit.

4. Which of the following theories explains that organizations are made up of intertwined links and diversified choices that generate unanticipated consequences?

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

Correct answer: D

Rationale: The chaos theory explains that organizations are made up of intertwined links and diversified choices that generate unanticipated consequences. Choice A, Contingency theory, focuses on how organizations adapt to their environment. Choice B, Closed system theory, suggests that organizations are self-contained and do not interact with their environment. Choice C, Open system theory, emphasizes that organizations interact with their environment but does not specifically address intertwined links and diversified choices generating unanticipated consequences.

5. A nurse is preparing to apply a dressing for a client who has a stage 2 pressure injury. Which of the following types of dressing should the nurse use?

• A. Hydrocolloid
• B. Transparent
• C. Gauze
• D. Alginate

Correct answer: A

Rationale: The correct answer is A: Hydrocolloid. For a stage 2 pressure injury, a hydrocolloid dressing is recommended. Hydrocolloid dressings provide a moist environment that promotes healing and is effective for wounds with moderate exudate. Choice B (Transparent) is not typically used for stage 2 pressure injuries as it is more suitable for superficial wounds. Choice C (Gauze) is not ideal for stage 2 pressure injuries as it can adhere to the wound bed and cause trauma upon removal. Choice D (Alginate) is more appropriate for wounds with heavy exudate, not typically seen in stage 2 pressure injuries.

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