Nursing Elites

1. The client has received IV solutions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the IV site is tender to palpation and a red streak has formed. Which action should the nurse implement first?

• A. Start a new IV in the right hand.
• B. Discontinue the intravenous line.
• C. Complete an incident record.
• D. Place a warm washcloth over the site.

Correct answer: B

Rationale: The first action should be to discontinue the intravenous line to prevent further complications such as infection or thrombophlebitis. Starting a new IV in the right hand is not the priority as addressing the current issue is important. Completing an incident record can be done after addressing the immediate concern of the IV site. Placing a warm washcloth over the site does not address the red streak and tenderness, which may indicate an infection that requires discontinuation of the IV line.

2. The client with type 2 DM is receiving dietary instructions from the nurse regarding the prescribed diabetic diet. The nurse determines that the client understands the instructions if the client states that:

• A. I need to skip meals if my blood glucose level is elevated.
• B. I need to eat a small meal or snack every 2 to 3 hours.
• C. I need to avoid using concentrated sweets in my diet.
• D. I need to eat a high-protein, low-carbohydrate diet.

Correct answer: C

Rationale: The correct answer is C: 'I need to avoid using concentrated sweets in my diet.' Clients with type 2 diabetes should avoid concentrated sweets as they can cause rapid spikes in blood glucose levels, which can be detrimental to their health. Option A is incorrect because skipping meals can lead to fluctuations in blood glucose levels. Option B is incorrect as it does not address the specific issue of avoiding concentrated sweets. Option D is incorrect because a high-protein, low-carbohydrate diet is not typically recommended as the primary approach for managing type 2 diabetes.

3. A client with hypothyroidism is receiving levothyroxine therapy. The healthcare provider should monitor for which of the following signs of medication overdose?

• A. Bradycardia
• B. Weight gain
• C. Tachycardia
• D. Cold intolerance

Correct answer: C

Rationale: The correct answer is C: Tachycardia. Tachycardia is a sign of levothyroxine overdose, indicating that the dose may need to be adjusted. Bradycardia (Choice A) is a sign of hypothyroidism, not an overdose of levothyroxine. Weight gain (Choice B) and cold intolerance (Choice D) are also symptoms of hypothyroidism, not medication overdose.

4. What is the nurse manager’s role in improving the quality of care on the unit?

• A. The nurse manager is responsible for setting goals and priorities for the unit and ensuring that staff members are working towards achieving those goals.
• B. The nurse manager is responsible for monitoring patient outcomes and implementing changes to improve the quality of care on the unit.
• C. The nurse manager is responsible for ensuring that staff members follow established procedures and protocols to maintain the quality of care on the unit.
• D. The nurse manager is responsible for providing feedback and coaching to staff members to help them improve their performance and achieve the unit’s quality goals.

Correct answer: A

Rationale: The nurse manager plays a crucial role in improving the quality of care on the unit by setting goals and priorities for the unit and ensuring that staff members are working towards achieving those goals. This involves strategic planning, coordination, and leadership to guide the team in delivering high-quality patient care. Option B is incorrect as while monitoring patient outcomes is important, it is not the primary role of the nurse manager in improving care quality. Option C is incorrect because while ensuring staff adherence to procedures is important, it is a part of maintaining quality rather than actively improving it. Option D is incorrect as providing feedback and coaching, though essential, is not the primary role of the nurse manager in setting goals and priorities for quality improvement.

5. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

• A. Administer desmopressin while the suspension is cold.
• B. Your condition isn't chronic, so you won't need to wear a medical identification bracelet.
• C. You may not be able to use desmopressin nasally if you have nasal discharge or blockage.
• D. You won't need to monitor your fluid intake and output after you start taking desmopressin.

Correct answer: C

Rationale: The correct instruction is choice C: 'You may not be able to use desmopressin nasally if you have nasal discharge or blockage.' Nasal congestion or blockage can interfere with the absorption of nasally administered desmopressin. Choices A, B, and D are incorrect. Choice A is unnecessary as the temperature of the suspension does not impact desmopressin administration. Choice B is incorrect as wearing a medical identification bracelet is essential for individuals with diabetes insipidus to alert healthcare providers in case of emergencies. Choice D is incorrect as monitoring fluid intake and output is crucial when taking desmopressin to ensure proper hydration and medication effectiveness.

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