Nursing Elites

1. A nurse is planning task assignments for the day. Which task should the nurse assign to the nursing assistant?

• A. Suctioning a client who requires periodic suctioning
• B. Assessing a client who has undergone an arteriogram and requires close monitoring
• C. Performing colostomy irrigation on a client with an ostomy
• D. Assisting a client who needs frequent ambulation with a walker

Correct answer: D

Rationale: When delegating tasks, a nurse must consider the staff member's education and competency level. Noninvasive tasks like helping a client ambulate with a walker are usually suitable for nursing assistants. Suctioning a client and colostomy irrigation are invasive procedures that require a licensed nurse's skills. Assessing a client post-arteriogram for any complications or changes in condition also necessitates the expertise of a licensed nurse. Therefore, the most appropriate task to assign to a nursing assistant is assisting a client who needs frequent ambulation with a walker.

2. An LPN is working on the care plan for a client with diabetes mellitus. Which of these outcomes would be the most appropriate?

• A. The client will maintain a blood glucose level within the normal range of 70-110 (per facility policy) throughout my shift.
• B. The client will maintain a blood glucose level within normal range limits today.
• C. The client will maintain a blood glucose level within the normal range of 70-110 (per facility policy) throughout my shift.
• D. The client will maintain a blood glucose level within normal limits throughout my shift.

Correct answer: C

Rationale: The correct answer is 'The client will maintain a blood glucose level within the normal range of 70-110 (per facility policy) throughout my shift.' This outcome is specific, measurable, and aligns with the goal of managing diabetes mellitus. Choice A is correct because it provides a clear target range (70-110) and includes adherence to facility policy, making it precise and goal-oriented. Choice B lacks specificity on the timeframe, and Choice D is vague in defining the target blood glucose range. In nursing care plans, outcomes should be well-defined, achievable, and measurable to effectively monitor the client's progress in managing their condition.

3. The graduate licensed practical nurse is assigned to care for the client on ventilator support, pending organ donation. Which goal should receive priority?

• A. Maintain the client's systolic blood pressure at 70mmHg or greater
• B. Maintain the client's urinary output greater than 300cc per hour
• C. Maintain the client's body temperature above 33�F rectal
• D. Maintain the client's hematocrit below 30%

Correct answer: A

Rationale: When caring for a client on ventilator support pending organ donation, maintaining the systolic blood pressure at 70mmHg or greater is crucial to ensure a proper blood supply to the donor organ. This goal is a priority to maintain the viability of the organ for donation. Choices B, C, and D are incorrect because they are unnecessary and not directly related to the immediate goal of organ donation. Maintaining urinary output, body temperature, or hematocrit levels are not the primary concerns in this situation.

4. The nurse is teaching a client about erythema infectiosum. Which of the following factors is not correct?

• A. There is no rash.
• B. The disorder is uncommon in adults.
• C. There is no fever.
• D. There is sometimes a 'slapped face' appearance.

Correct answer: B

Rationale: The correct answer is B: 'The disorder is uncommon in adults.' Erythema infectiosum, also known as Fifth's disease, is more common in children than in adults. It typically presents with a rash on the face that gives a 'slapped cheek' or 'slapped face' appearance. Fever may be present, and there is a characteristic rash associated with the condition. Therefore, the statement 'The disorder is uncommon in adults' is incorrect, making it the correct answer. The other statements are true regarding erythema infectiosum, making them incorrect choices. There is indeed a rash associated with erythema infectiosum, which can be a prominent feature. Fever may also be present in individuals with this condition. Additionally, the 'slapped face' appearance is a classic characteristic of erythema infectiosum.

5. A case manager is serving on a community task force on violence in schools. The members of the task force are planning to develop interventions to help prevent violence. According to the nursing process, which is the first activity that the case manager would suggest to the task force?

• A. Teaching schoolchildren about the dangers of school violence
• B. Conducting a community survey to assess community perceptions regarding school violence
• C. Looking at what other communities are doing about school violence
• D. Distributing flyers that identify the causes of school violence to families in the community

Correct answer: B

Rationale: The correct answer is to conduct a community survey to assess community perceptions regarding school violence. In the nursing process, assessment is always the first step. By conducting a survey, the task force can gather important data about how the community perceives school violence, which is essential for developing effective interventions. Choices A, C, and D involve actions that come after the assessment phase. Teaching schoolchildren about the dangers of violence and distributing flyers are important activities but should come after understanding the community's perceptions and needs. Looking at what other communities are doing is valuable but should also follow a thorough assessment of the specific community's needs and perceptions.

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