Nursing Elites

1. A nurse manager is teaching a group of employees about standards for Quality and Safety Education for Nurses (QSEN). Which of the following statements by an employee should the nurse manager identify as an example of the QSEN concept of quality improvement?

• A. We should start tracking how soon clients are discharged after laparoscopic versus open surgery.
• B. We should involve our clients' partners in care planning as much as possible.
• C. We should be sure to log out of the computers immediately following documentation.
• D. We should provide change-of-shift report as a team, including the assistive personnel who assisted with care.

Correct answer: B

Rationale: Involving partners in care planning is a quality improvement strategy that aligns with QSEN principles. This choice reflects patient-centered care and collaboration, which are essential elements of quality improvement. Choices A, C, and D do not directly relate to quality improvement concepts. Tracking discharge times, logging out of computers, and providing change-of-shift reports are important practices but not specifically focused on quality improvement.

2. A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take?

• A. Aspirate for a blood return before depressing the plunger
• B. Insert the needle at a 45-degree angle
• C. Administer the medication 2.54 cm (1 in) from the umbilicus
• D. The nurse should not expel the air bubble in the prefilled syringe

Correct answer: D

Rationale: The correct action when administering enoxaparin is not to expel the air bubble in the prefilled syringe. Expelling the air bubble may lead to the loss of medication and result in an incomplete dose. Aspirating for a blood return (Choice A) is not necessary for subcutaneous injections like enoxaparin. Inserting the needle at a 45-degree angle (Choice B) is not specific to administering enoxaparin. Administering the medication 2.54 cm (1 in) from the umbilicus (Choice C) is not a standard guideline for enoxaparin administration.

3. A patient is being treated for dehydration. Which lab result would support the diagnosis?

• A. Elevated hemoglobin
• B. Low sodium level
• C. High white blood cell count
• D. Elevated BUN

Correct answer: D

Rationale: Elevated BUN levels are a characteristic finding in dehydration due to reduced kidney perfusion and increased reabsorption of urea. Hemoglobin levels might be elevated in conditions like polycythemia vera, not directly related to dehydration. A low sodium level could be seen in conditions like hyponatremia. A high white blood cell count is more indicative of infection or inflammation rather than dehydration.

4. A nurse is planning a staff education program to review nursing interventions for clients who have kidney failure. Which of the following sources should the nurse identify as the best resource for obtaining evidence-based information?

• A. The advice of an expert nephrology nurse
• B. Retrospective chart reviews
• C. Facility critical pathway
• D. A recent peer-reviewed nursing research article

Correct answer: D

Rationale: A peer-reviewed nursing research article is the best resource for obtaining evidence-based information because it provides the most current and reliable data on nursing interventions. Choice A, the advice of an expert nephrology nurse, may be helpful but could be based on individual experience rather than the latest research. Retrospective chart reviews (Choice B) focus on past cases and may not reflect current best practices. Facility critical pathways (Choice C) offer standardized care plans but may not always incorporate the most up-to-date evidence-based practices.

5. How does a healthcare professional assess a patient's fluid balance, and what signs indicate fluid overload?

• A. Checking lung sounds for crackles
• B. Checking for signs of orthopnea
• C. Monitoring intake and output, and checking for edema
• D. Measuring daily weight

Correct answer: C

Rationale: The correct answer is monitoring intake and output and checking for edema. Monitoring intake and output provides information about fluid balance in the body, while checking for edema helps assess for fluid overload. Lung sounds and signs of orthopnea are more indicative of respiratory issues rather than fluid balance. Daily weight measurement is useful to assess fluid status, but it alone may not provide a comprehensive evaluation of fluid balance.

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