Nursing Elites

1. The nurse working on a mental health unit is prioritizing nursing care activities due to a staffing shortage. One practical nurse (PN) is on the unit with the nurse, and another RN is expected to arrive within two hours. Clients need to be awakened, and morning medications need to be prepared. Which plan is best for the nurse to implement?

• A. Wake all the clients and instruct them to go to the dining area for medication administration
• B. Explain to the clients that it will be necessary to cooperate until another RN arrives
• C. Ask the PN to administer medications as clients are awakened so both nurses are available
• D. Allow the clients to sleep until a third staff person can assist with unit activities

Correct answer: C

Rationale: The best plan for the nurse to implement is to ask the PN to administer medications as clients are awakened. This approach ensures that medication administration and client care are efficiently managed despite the staffing shortage. Option A is incorrect as it may disrupt the workflow and create unnecessary chaos. Option B is not the best choice as it does not address the immediate need for medication administration. Option D is not ideal as it delays client care until additional staff arrive, potentially compromising patient safety and timely medication administration.

2. A client with type 2 diabetes mellitus is admitted for frequent hyperglycemic episodes and a glycosylated hemoglobin (HbA1c) of 10%. Insulin glargine 10 units subcutaneously once a day at bedtime and a sliding scale with insulin aspart q6h are prescribed. What action should the nurse include in this client’s plan of care?

• A. Perform fingerstick glucose assessment q6h with meals
• B. Mix bedtime dose of insulin glargine with insulin aspart sliding scale dose
• C. Review proper foot care and prevention of injury with the client
• D. Avoid contaminating the insulin aspart for IV use

Correct answer: A

Rationale: Performing fingerstick glucose assessments q6h with meals is essential in monitoring the client's blood glucose levels closely, especially when managing hyperglycemic episodes and adjusting insulin doses with a sliding scale. This action helps in determining the effectiveness of the prescribed insulin regimen. Reviewing proper foot care and preventing injury is important for long-term diabetic management but not the immediate priority in this scenario. Mixing insulin glargine with insulin aspart is not recommended, as they are different types of insulin with distinct mechanisms of action. Ensuring the availability of insulin aspart for IV use is not relevant to the client's current care plan.

3. The client who is to avoid any weight-bearing on the left leg is using a 3-point crutch gait for ambulation. What is the best action for the nurse to initiate?

• A. Encourage continued use of the 3-point crutch gait by the client
• B. Encourage the client to use a wheelchair for mobility
• C. Instruct the client in the use of a 4-point crutch gait
• D. Instruct the client in the use of a 2-point crutch gait

Correct answer: C

Rationale: In this scenario, the client needs to avoid weight-bearing on the left leg. A 4-point crutch gait involves using both crutches and both legs, making it more appropriate for weight-bearing restrictions. Encouraging the use of a 3-point gait (choice A) would not provide adequate support for the client's condition. While using a wheelchair (choice B) could be an option, instructing the client in a 4-point crutch gait would promote mobility while adhering to weight-bearing restrictions. A 2-point crutch gait (choice D) involves using both crutches and one leg, which is not suitable for avoiding weight-bearing on the left leg.

4. A 10-month-old girl is admitted with a diagnosis of possible cystic fibrosis. What question should the nurse ask the parent to assist in the diagnosis of cystic fibrosis (CF)?

• A. When you kiss her, does she taste salty?
• B. Do you notice if her urine has a musty odor?
• C. Has she been drinking cow's milk in her daily diet?
• D. How often does she have a normal bowel movement?

Correct answer: A

Rationale: The correct answer is A. Salty skin is a common sign of cystic fibrosis due to high levels of sodium in sweat. Asking about the taste of the child's skin provides valuable information related to the diagnosis of CF. Choices B, C, and D are not helpful in diagnosing cystic fibrosis. A musty odor in urine is not a typical symptom of CF. Drinking cow's milk or bowel movement frequency are not specific to CF diagnosis.

5. Which client is at the greatest risk for developing delirium?

• A. An adult client who cannot sleep due to constant pain
• B. An older client who attempted suicide 1 month ago
• C. A young adult who takes antipsychotic medications twice a day
• D. A middle-aged woman who uses a tank for supplemental oxygen

Correct answer: B

Rationale: The correct answer is B because older adults are at higher risk for delirium, especially following a recent suicide attempt, which can be a significant stressor. Choice A is less likely to develop delirium solely due to difficulty sleeping; delirium is more complex and multifactorial. Choice C, a young adult taking antipsychotic medications, may be at risk for other conditions but not necessarily delirium. Choice D, a middle-aged woman using supplemental oxygen, is not directly linked to an increased risk of delirium compared to the older client who recently attempted suicide.

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