Nursing Elites

1. When a client is receiving pain medication through a PCA pump, which of the following actions should the nurse take?

• A. Educate the family not to push the button for the client while the client is asleep.
• B. Explain to the client that vital signs will be monitored regularly due to being on a PCA pump.
• C. Instruct the client to push the button only when pain is above a 7 on a scale of 0 to 10.
• D. Adjust the basal rate and decrease the lock-out interval time if the client's pain level is too high.

Correct answer: D

Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.

2. The time period to give as notice for an appraisal is:

• A. One day.
• B. None.
• C. One week.
• D. Two days.

Correct answer: D

Rationale: The correct answer is D: 'Two days.' It is preferable to give two days' notice for a performance appraisal. Giving only one day's notice (Choice A) might not provide sufficient time for the employee to prepare adequately for the appraisal. Choice B, 'None,' is incorrect because it is essential to give advance notice for an appraisal to allow the employee time to get ready. Choice C, 'One week,' is too long of a notice period for a standard performance appraisal and could lead to unnecessary delays.

3. Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates the most urgent need for the nurse�s assessment of the patient?

• A. Bedtime glucose of 140 mg/dL
• B. Noon blood glucose of 52 mg/dL
• C. Fasting blood glucose of 130 mg/dL
• D. 2-hr postprandial glucose of 220 mg/dL

Correct answer: B

Rationale:

4. Which of the following describes the concept of ratification?

• A. Contract administration
• B. Contract passage
• C. Contract denial
• D. Contract reorganization

Correct answer: B

Rationale: The correct answer is B: 'Contract passage.' Ratification refers to the approval or confirmation of a contract by a simple majority of members who vote to pass it. Choice A, 'Contract administration,' does not accurately describe ratification as it focuses more on the management of contracts rather than their approval. Choice C, 'Contract denial,' is incorrect as ratification implies acceptance or approval, not denial. Choice D, 'Contract reorganization,' is also incorrect as ratification does not involve restructuring or reorganizing a contract, but rather confirming its validity.

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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