Nursing Elites

1. The nurse is caring for a client with a diagnosis of myocardial infarction (MI). Which intervention is a priority during the acute phase?

• A. Administer morphine for pain relief.
• B. Encourage the client to perform isometric exercises.
• C. Position the client flat in bed.
• D. Restrict fluid intake.

Correct answer: A

Rationale: Administering morphine is a priority intervention during the acute phase of myocardial infarction (MI). Morphine not only provides pain relief but also reduces myocardial oxygen demand, which is crucial in this situation. Choice B is incorrect because isometric exercises can increase myocardial oxygen demand and are not recommended during the acute phase of MI. Choice C is incorrect as elevating the head of the bed, not keeping the client flat, is preferred to reduce workload on the heart. Choice D is incorrect because fluid intake should be encouraged unless contraindicated, as adequate hydration is essential for cardiac function.

2. Which nursing activity is within the scope of practice for the practical nurse?

• A. Complete an admission assessment in the normal newborn nursery
• B. Discontinue a central venous catheter that has become dislodged
• C. Observe a client rotate the subcutaneous site for an insulin pump
• D. Monitor a continuous narcotic epidural for a postoperative client

Correct answer: C

Rationale: The correct answer is C: 'Observe a client rotate the subcutaneous site for an insulin pump.' This activity is within the scope of practice for a practical nurse as it involves observing and ensuring proper technique for using an insulin pump, which aligns with their training and responsibilities. Choices A, B, and D are beyond the typical scope of practice for a practical nurse. Completing an admission assessment for a newborn nursery is usually performed by a registered nurse. Discontinuing a dislodged central venous catheter and monitoring a narcotic epidural require advanced skills and knowledge, usually carried out by registered nurses or advanced practice nurses.

3. After delivering a healthy newborn, a client is experiencing postpartum hemorrhage. What initial intervention should the nurse implement?

• A. Administer IV fluids
• B. Perform a uterine massage
• C. Monitor the newborn's vital signs
• D. Notify the healthcare provider

Correct answer: B

Rationale: The correct initial intervention for postpartum hemorrhage is to perform a uterine massage. This action helps the uterus contract, controlling bleeding. Administering IV fluids may be necessary but is not the initial intervention. Monitoring the newborn's vital signs is important but not the priority when managing postpartum hemorrhage. Notifying the healthcare provider can be done after initiating immediate interventions to address the hemorrhage.

4. A client with type 1 diabetes is experiencing symptoms of hypoglycemia. What is the nurse's priority intervention?

• A. Administer glucagon intramuscularly
• B. Provide a complex carbohydrate snack
• C. Administer 50% dextrose intravenously
• D. Give 15 grams of a fast-acting carbohydrate

Correct answer: D

Rationale: The priority intervention for a client with type 1 diabetes experiencing symptoms of hypoglycemia is to give 15 grams of a fast-acting carbohydrate. In a hypoglycemic state, the priority is to quickly raise the blood glucose level. Administering glucagon intramuscularly (Choice A) is reserved for severe hypoglycemia when the client is unable to take oral carbohydrates. Providing a complex carbohydrate snack (Choice B) is beneficial after the initial treatment of hypoglycemia to prevent recurrence. Administering 50% dextrose intravenously (Choice C) is a more invasive intervention typically done in a hospital setting for severe cases.

5. A terminally ill male client and his family request hospice care after discharge. What aspect of care should the nurse indicate is the focus of hospice?

• A. Enhance symptom management to improve end-of-life quality
• B. Facilitate assisted suicide with the client's consent
• C. Offer ways to postpone the death experience at home
• D. Provide training for family members to care for the client

Correct answer: A

Rationale: The correct answer is A. Hospice care focuses on enhancing symptom management to improve the end-of-life quality for terminally ill patients and their families. Hospice aims to provide comfort, dignity, and support during the end-of-life journey. Choice B is incorrect as hospice care does not involve assisted suicide but focuses on providing palliative care. Choice C is incorrect as hospice care does not aim to postpone the death experience but rather to provide support and comfort during this time. Choice D is incorrect as while hospice care may involve educating family members on caring for the client, the primary focus is on symptom management and quality of life.

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