Nursing Elites

1. A discharge planning nurse is making arrangements for a client with an epidural catheter for continuous infusion of opioids to be placed in a long-term care facility. The family prefers a facility in its neighborhood to facilitate visiting. The neighborhood facility has never cared for a client with this type of need. What is the most appropriate action by the discharge planning nurse?

• A. Arrange for immediate in-services for the long-term care facility staff on pain management using epidural catheters.
• B. Explain the situation to the client and family and seek another long-term care facility for discharge from the hospital.
• C. Encourage the family to hire private duty nurses skilled in epidural catheter pain management to allow the client to be transferred to the neighborhood facility.
• D. None of the above

Correct answer: B

Rationale: In this scenario, the priority is the safety and well-being of the client. The neighborhood facility's lack of experience in caring for a client with an epidural catheter for continuous opioid infusion raises concerns about the quality of care they can provide. Therefore, the most appropriate action for the discharge planning nurse is to explain the situation to the client and family and seek another long-term care facility that can provide the necessary care. Option A, arranging for immediate in-services, may not be feasible or timely, considering the urgent need for appropriate care. Option C, encouraging the family to hire private duty nurses, does not ensure the facility's overall capability to manage the client's complex needs. Option D, 'None of the above,' is not the best choice as the client's safety should be the priority in this situation.

2. Which of the following medications might cause upper-gastrointestinal (UGI) bleeding?

• A. Cardizem (diltiazem)
• B. Naprosyn (naproxen)
• C. Elavil (amitriptyline)
• D. Corgard (nadolol)

Correct answer: C

Rationale: Naprosyn (naproxen) is known to cause upper-gastrointestinal (UGI) bleeding due to its effects on the stomach lining. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the stomach and increase the risk of UGI bleeding. On the other hand, Cardizem (diltiazem), Elavil (amitriptyline), and Corgard (nadolol) are not typically associated with UGI bleeding. Cardizem is a calcium channel blocker used for hypertension and angina, Elavil is a tricyclic antidepressant, and Corgard is a beta-blocker used for hypertension.

3. When assessing a client with amyotrophic lateral sclerosis (ALS), the nurse should expect which of the following findings?

• A. mental confusion
• B. muscular weakness
• C. sensory loss
• D. emotional liability

Correct answer: B

Rationale: Clients with ALS typically present with progressive muscular weakness and wasting as a hallmark feature of the disease. This weakness affects voluntary muscles, leading to challenges in mobility and daily activities. Sensory loss is not a characteristic feature of ALS, and individuals usually maintain their mental clarity without experiencing mental confusion. Emotional liability, characterized by sudden, uncontrolled changes in emotions, is not a common finding in ALS. While individuals may experience periods of grief due to the progressive nature of the disease, emotional liability is not a usual manifestation. Therefore, the correct finding to expect when assessing a client with ALS is muscular weakness.

4. A client with diabetes mellitus who takes a daily dose of NPH insulin has a hard time drawing the insulin into a syringe because he has difficulty seeing the markings on the syringe. To which services does the nurse suggest a referral?

• A. Home care
• B. Occupational therapy
• C. Social services
• D. Physical therapy

Correct answer: B

Rationale: For a client with diabetes mellitus who struggles to draw insulin due to poor vision, the nurse should suggest a referral to home care services. Home care provides various support services, including assistance with insulin administration. In this scenario, a home care nurse can prefill a week's supply of syringes with the correct insulin dose for the client. These syringes can be stored in the client's refrigerator for self-administration. Occupational therapy focuses on helping individuals with activities of daily living, such as using adaptive devices. Social services typically address counseling and financial aspects of care. Physical therapy is geared towards treating physical disabilities or impairments through exercises and techniques.

5. Which action exemplifies the use of evidence-based practice in the delivery of client care?

• A. Advising a client to agree to the treatment recommended by their healthcare provider
• B. Taking a rectal temperature from a client for whom bleeding precautions have been instituted
• C. Donning sterile gloves to change an abdominal wound dressing
• D. Encouraging a client to take an herbal substance to treat their insomnia

Correct answer: C

Rationale: Evidence-based practice is an approach to client care where the nurse integrates the client’s preferences, clinical expertise, and the best research evidence to deliver quality care. Donning sterile gloves to change an abdominal wound dressing exemplifies evidence-based practice as it prevents the entrance of harmful bacteria into the wound, following best practice guidelines. The other options do not align with evidence-based practice. Advising a client to agree to a treatment does not involve integrating research evidence. Taking herbal substances may not be supported by strong research evidence and can pose risks. Additionally, rectal temperature-taking in a client with bleeding precautions can increase the risk of injury to the rectal mucosa, not aligning with best practices in care delivery.

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