Nursing Elites

1. A provider has written a do not resuscitate (DNR) order for a client who is comatose and does not have advance directives. A member of the client’s family says, 'I wonder when the doctor will tell us what’s going on.' Which of the following actions should the nurse take first?

• A. Request that the provider provide more information to the family.
• B. Refer the family to a support group for grief counseling.
• C. Offer to answer questions that family members have.
• D. Ask the family what the provider has discussed with them.

Correct answer: D

Rationale: The correct action for the nurse to take first is to ask the family what the provider has discussed with them. This allows the nurse to clarify any misunderstandings and ensures that the family is fully informed before providing further information. Option A is not the best choice because it assumes the need for more information without first understanding what has already been communicated. Option B is premature as the family may not be ready for grief counseling at this stage. Option C, although a good general practice, is not the most appropriate immediate action in this situation where clarifying existing information is crucial.

2. A nurse enters a client's room and sees smoke coming from the trash can. Which of the following actions should the nurse take first?

• A. Close the window
• B. Evacuate the room
• C. Call the fire department
• D. Attempt to extinguish the fire

Correct answer: B

Rationale: The correct answer is to evacuate the room first. In a fire situation, the priority is safety, following the RACE protocol: Rescue, Alarm, Contain, Extinguish. Evacuating the room ensures the safety of both the client and the nurse. Closing the window (Choice A) can wait until after evacuation when there is no immediate danger. Calling the fire department (Choice C) is important but comes after ensuring personal safety and evacuating. Attempting to extinguish the fire (Choice D) is not recommended as it can put the nurse and the client at risk; firefighting should be left to professionals.

3. A nurse is caring for a client with congestive heart failure. Which of the following prescriptions should the nurse anticipate?

• A. Call the provider if the respiratory rate is less than 18/min
• B. Administer a 500 mL IV bolus of 0.9% sodium chloride over 1 hour
• C. Administer enalapril 2.5 mg PO twice daily
• D. Call the provider if the client’s pulse rate is less than 80/min

Correct answer: C

Rationale: Enalapril, an ACE inhibitor, is commonly prescribed to manage hypertension and heart failure. It helps reduce the workload on the heart and prevent fluid retention. Options A, B, and D are incorrect. Option A focuses on a respiratory rate, which is not specific to heart failure management. Option B suggests administering a large IV bolus of fluid, which can worsen heart failure by increasing fluid volume. Option D addresses the pulse rate, which is not a typical parameter to monitor for heart failure specifically.

4. A charge nurse is making assignments for the upcoming shift. What assignment should the charge nurse give to an LPN?

• A. A client who requires complex medication management
• B. A client who has dehydration and inflammatory bowel disease (IBD)
• C. A client needing assessment of a new diagnosis
• D. A client requiring a nursing care plan update

Correct answer: B

Rationale: The correct assignment for an LPN would be a client who has dehydration and inflammatory bowel disease (IBD). This choice is appropriate because it involves monitoring the client's condition, providing basic care, and assisting with activities of daily living, which align with the scope of practice for LPNs. Choices A, C, and D involve tasks that are more complex and require a higher level of nursing education and training, making them less suitable for an LPN.

5. A nurse manager is teaching a group of employees about QSEN. What statement by an employee should the nurse manager identify as quality improvement?

• A. We should track the rate of hospital-acquired infections.
• B. We should evaluate patient satisfaction scores.
• C. We should start tracking how soon patients are discharged after laparoscopic versus open surgery.
• D. We should check the patient's temperature before discharge.

Correct answer: C

Rationale: The correct answer is C. QSEN focuses on quality improvement in healthcare. Tracking how soon patients are discharged after different types of surgeries helps in evaluating the quality of care provided and identifying areas for improvement. Choices A and B focus on monitoring outcomes but do not directly relate to quality improvement initiatives. Choice D is more about a routine assessment before discharge and does not involve a quality improvement process.

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