Nursing Elites

1. A nurse is supervising an assistive personnel (AP) who is feeding a client who has dysphagia. Which of the following actions by the AP should the nurse identify as correct technique?

• A. Elevating the head of the client's bed to 30 degrees during mealtime
• B. Withholding fluids until the end of the meal
• C. Providing a 10-minute rest period prior to meals
• D. Instructing the client to place her chin toward her chest when swallowing

Correct answer: D

Rationale: The correct technique for a client with dysphagia is to instruct them to place their chin toward their chest when swallowing. This action helps to close off the airway during swallowing, reducing the risk of aspiration. Elevating the head of the client's bed to 30 degrees during mealtime helps prevent aspiration, but this is not the responsibility of the AP. Withholding fluids until the end of the meal can lead to dehydration and is not a recommended practice. Providing a 10-minute rest period prior to meals is not specifically related to improving swallowing safety for clients with dysphagia.

2. Alcohol, caffeine, or drugs are high-risk factors that all fall under which broad classification of risk factors?

• A. Social demographic
• B. Environmental
• C. Biophysical
• D. Psychosocial

Correct answer: D

Rationale: The correct answer is D: Psychosocial. Alcohol, caffeine, or drug use are considered psychosocial risk factors as they are related to individual behavior, lifestyle choices, and social interactions. Choices A, B, and C are incorrect. Social demographic factors (choice A) refer to characteristics of a population such as age, gender, education, income, etc. Environmental factors (choice B) include physical surroundings like air quality, housing conditions, etc. Biophysical factors (choice C) involve biological aspects like genetics, physiology, and health conditions.

3. Select the stage of shock that is accurately paired with its characteristic.

• A. The initial stage of shock: Hyperventilation occurs and the blood pH rises.
• B. The compensatory stage of shock: Hypoxia occurs and lactic acid rises.
• C. The progressive stage of shock: Histamine is released; fluid and proteins leak into surrounding tissues and the blood thickens.
• D. The refractory stage of shock: Potassium ions leak out; sodium ions build up, and metabolic acidosis increases.

Correct answer: C

Rationale: The progressive stage of shock is accurately described as the stage where histamine is released, leading to fluid and proteins leaking into surrounding tissues and the blood thickening. In this stage, the body's compensatory mechanisms are overwhelmed, resulting in a cascade of events that worsen the shock state. Choice A is incorrect as hyperventilation and a rise in blood pH are more characteristic of the compensatory stage. Choice B is incorrect as hypoxia and a rise in lactic acid are more typical of the progressive stage. Choice D is incorrect as the described electrolyte imbalances and metabolic acidosis are more aligned with the refractory stage of shock.

4. A nurse manager is leading a discussion about ethical dilemmas. Which of the following situations should the nurse manager include as an example of an ethical dilemma?

• A. A visitor experiences a minor burn after spilling coffee
• B. A client receives an operation on the wrong side of her body
• C. A parent wants her 14-year-old adolescent to receive radiation treatment against his will
• D. A nurse witnesses another nurse administer an incorrect medication

Correct answer: C

Rationale: An ethical dilemma involves a situation where moral principles conflict, such as in the case of a parent wanting their adolescent to receive treatment against their will. In option A, a minor burn from spilled coffee does not present a conflict of moral principles. Option B describes a medical error, not necessarily a conflict of moral principles. Option D involves an issue of professional practice and patient safety but does not inherently pose a conflict of moral principles.

5. The doctor has ordered 1,000 cc of intravenous fluid every 8 hours. You will be using intravenous tubing that delivers 20 cc/drop. At what rate will you adjust the intravenous fluid flow? _____ gtts per minute.

• A. 38 gtts/min
• B. 42 gtts/min
• C. 50 gtts/min
• D. 40 gtts/min

Correct answer: D

Rationale: To calculate the rate: 1000 cc/8 hours = 125 cc/hour. 125 cc/hour * 1 drop/20 cc * 1 hour/60 minutes = 40 gtts/min. Therefore, the correct answer is 40 gtts/min. Choice A (38 gtts/min) is incorrect as it doesn't match the calculation result. Choice B (42 gtts/min) is incorrect as it is not the calculated rate. Choice C (50 gtts/min) is incorrect as it is not the calculated rate either.

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