Nursing Elites

1. A patient reports feeling dizzy when standing up. What is the most appropriate nursing intervention?

• A. Encourage the patient to take deep breaths.
• B. Assist the patient to sit down slowly.
• C. Instruct the patient to use a walker for support.
• D. Teach the patient how to change positions safely.

Correct answer: B

Rationale: The correct answer is to assist the patient to sit down slowly. This intervention is appropriate for a patient experiencing dizziness when standing up, as it helps prevent falls due to orthostatic hypotension. Encouraging deep breaths (Choice A) may not address the underlying cause of dizziness, which is related to postural changes. Instructing the patient to use a walker for support (Choice C) or teaching the patient how to change positions safely (Choice D) are not the most immediate and direct interventions to address the immediate risk of falling when feeling dizzy upon standing.

2. What is the priority action for a patient with a fever?

• A. Administer an antipyretic medication as prescribed.
• B. Assess the patient's temperature regularly.
• C. Provide cooling measures such as a cool compress.
• D. Provide the patient with blankets for comfort.

Correct answer: B

Rationale: The priority action when a patient has a fever is to assess the patient's temperature regularly. Monitoring the temperature helps track the effectiveness of interventions and detect any worsening fever. Administering antipyretic medication (Choice A) should be done based on healthcare provider's orders after assessing the patient's condition. While providing cooling measures such as a cool compress (Choice C) can help reduce fever, assessing the temperature takes precedence. Providing blankets for comfort (Choice D) is not the priority when dealing with a fever.

3. How should a healthcare provider respond when a patient expresses concerns about the side effects of a prescribed medication?

• A. Reassure the patient that side effects are rare.
• B. Discuss the benefits and risks of the medication with the patient.
• C. Encourage the patient to speak to the pharmacist.
• D. Refer the patient to another healthcare provider for information.

Correct answer: B

Rationale: When a patient expresses concerns about medication side effects, it is crucial for the healthcare provider to discuss the benefits and risks of the medication with the patient. This approach helps the patient make an informed decision about their treatment. Choice A is incorrect because dismissing the patient's concerns by reassuring them that side effects are rare may not address the patient's specific worries. Choice C, while pharmacists can provide valuable information, the primary responsibility lies with the healthcare provider. Choice D is incorrect as referring the patient to another healthcare provider may disrupt continuity of care and not address the patient's concerns effectively.

4. A client has a prescription for vancomycin 1g IV intermittent infusion over 30 minutes every 12 hours. What action should the nurse take?

• A. Start the infusion immediately
• B. Slow down the infusion rate
• C. Contact the provider for prescription clarification
• D. Check blood pressure during the infusion

Correct answer: C

Rationale: The correct action for the nurse to take is to contact the provider for prescription clarification. Administering vancomycin over less than 60 minutes can lead to infusion reactions like hypotension and flushing. Starting the infusion immediately (choice A) is incorrect as it goes against the prescribed rate. Slowing down the infusion rate (choice B) without provider approval can result in underdosing the medication. Checking blood pressure during the infusion (choice D) is important but not the most immediate action needed in this situation.

5. A client requires suctioning every 2 hours. To whom should the nurse delegate this task?

• A. Delegate to a licensed practical nurse (LPN)
• B. Delegate to a registered nurse (RN)
• C. Delegate to a nursing assistant (NA)
• D. Perform the task independently

Correct answer: A

Rationale: The correct answer is to delegate the task to a licensed practical nurse (LPN). LPNs can typically perform suctioning, but it is essential to consider the state's practice guidelines and hospital policy. Option B, delegating to a registered nurse (RN), is not necessary for this task as LPNs are usually competent to handle suctioning. Option C, delegating to a nursing assistant (NA), may not be appropriate as suctioning may require a higher level of training and expertise. Option D, performing the task independently, is not the best choice as delegation is a key aspect of nursing practice to ensure tasks are appropriately assigned based on competency levels.

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