Nursing Elites

1. The LPN is receiving the report on a comatose client at the start of the shift at 1500. What statement should be of most concern?

• A. The client was repositioned on his right side at 1100.
• B. The client was bathed, and the skin was assessed head-to-toe at 0900 with no abnormal findings.
• C. The client's PEG tube was changed 6 months ago.
• D. The client's indwelling urinary catheter was last changed 5 days ago.

Correct answer: D

Rationale: When caring for a comatose client, it is crucial to monitor and maintain the integrity of the indwelling urinary catheter to prevent urinary tract infections and other complications. Changing the urinary catheter less frequently than recommended increases the risk of infection. In this scenario, the most concerning issue is the prolonged duration since the last change of the indwelling urinary catheter, which poses an immediate risk to the client's health. While repositioning every 2 hours is essential to prevent skin breakdown, the most critical aspect in this case is the catheter care. Bathing and skin assessment are important for overall hygiene and skin integrity but are not as urgent as catheter care. The timing of the PEG tube change, while relevant for care planning, is not as immediate a concern as the indwelling urinary catheter status.

2. A client is told that his test is positive, but in fact, the client does not have the disease tested for. Which type of false report is this an example of?

• A. positive
• B. false positive
• C. negative
• D. false negative

Correct answer: B

Rationale: The correct answer is 'false positive.' A false-positive result occurs when a test result is labeled positive in error, when the actual result is negative. In this scenario, the client received a positive test result incorrectly, as he does not have the disease being tested for. Choice A ('positive') is too vague and does not specify that the result was incorrect. Choice C ('negative') is the opposite of what happened in the scenario. Choice D ('false negative') refers to a situation where a test result is labeled negative incorrectly, which is not the case in this scenario.

3. When planning task assignments for five clients on the skilled nursing unit in a long-term care facility, which task should a licensed practical nurse (LPN) assign to another LPN?

• A. Bathing a client who is confused and requires assistance with a shower
• B. Administering regular insulin in accordance with a sliding-dosage scale every 4 hours to a client with diabetes mellitus
• C. Assisting a client requiring a bed bath and frequent ambulation with a cane
• D. Transporting a client who must be accompanied to physical therapy twice during the shift

Correct answer: B

Rationale: When assigning tasks, the nurse must consider the skills and educational level of the nursing staff. The nursing assistant may be assigned tasks like caring for a confused client, assisting with a shower or a bed bath, ambulating a client with a cane, and accompanying a client to physical therapy. The LPN is educated to administer medications like regular insulin in accordance with a sliding scale. This task requires a higher level of training and knowledge than the tasks that can be delegated to a nursing assistant. Administering insulin involves assessing blood glucose levels, calculating dosages, and understanding the effects of insulin therapy on the client's condition. Therefore, the correct answer is administering regular insulin to a client with diabetes mellitus. Choices A, C, and D involve tasks that are within the scope of practice of a nursing assistant, not an LPN.

4. Which of the following is least important to test when assessing the client’s motor skills?

• A. strength
• B. knowledge of ergonomics
• C. balance
• D. coordination

Correct answer: B

Rationale: When assessing a client’s motor skills, it is crucial to evaluate their strength, balance, and coordination as these directly impact their motor abilities. Strength is essential to perform tasks, balance is required for stability, and coordination is necessary for smooth movements. However, knowledge of ergonomics, while beneficial for overall understanding, is not directly related to assessing motor skills. The focus should be on physical abilities rather than theoretical knowledge of ergonomics. Therefore, testing the client’s knowledge of ergonomics is the least important when evaluating their motor skills.

5. An LPN on a Continuous Quality Improvement (CQI) team is tasked with implementing strategies to reduce medication errors. Which of the following strategies would be most beneficial for the LPN to implement?

• A. Track individuals who commit medication errors and report them to administration.
• B. Remind staff of the five rights of medication administration.
• C. Ensure that all staff members are proficient in completing incident reports if a medication error occurs.
• D. Double-check that staff document medication administration in the electronic medical record.

Correct answer: C

Rationale: The most beneficial strategy for the LPN on a CQI team to implement is to ensure that all staff members are proficient in completing incident reports if a medication error occurs. Organized and accurate incident reports are crucial in tracking and understanding why errors occurred. CQI teams utilize incident reports to develop new policies or enhance existing ones to standardize medical processes and reduce errors. Tracking individuals with medication errors (Choice A) may create a culture of blame rather than focusing on system improvements. Reminding staff of the five rights of medication administration (Choice B) is important for knowledge reinforcement but does not directly address the process improvement aspect. Double-checking documentation in the electronic medical record (Choice D) is necessary for accuracy but does not provide the detailed insights obtained from incident reports for process improvement.

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