Nursing Elites

1. The PN is caring for a client who had an acute brain attack with resulting expressive aphasia and urinary incontinence. To ensure care for the client, which task should the PN delegate to the UAP?

• A. Explain how to use a communication board
• B. Document progress in the use of the communication board
• C. Encourage voiding by assisting the client to the bedside commode
• D. Establish a bladder training schedule and methods

Correct answer: C

Rationale: Assisting the client to the bedside commode is an appropriate task for the UAP as it involves basic patient care and mobility assistance, which are within the UAP's scope of practice. Options A and B involve communication techniques and documentation, which are more appropriate for licensed nursing staff. Option D involves establishing a bladder training schedule, which requires assessment and planning skills beyond the UAP's role.

2. A client is recovering from a craniotomy and has a ventriculostomy in place. The nurse notices the drainage from the ventriculostomy is suddenly increasing. What should the nurse do first?

• A. Increase the head of the bed to 45 degrees.
• B. Clamp the ventriculostomy tube.
• C. Notify the healthcare provider immediately.
• D. Measure the client's head circumference.

Correct answer: C

Rationale: A sudden increase in drainage from a ventriculostomy could indicate a serious complication such as increased intracranial pressure or hemorrhage. The priority action in this situation is to notify the healthcare provider immediately to ensure prompt evaluation and intervention. Increasing the head of the bed may be beneficial in some situations but is not the first action to take. Clamping the ventriculostomy tube is inappropriate as it can lead to increased intracranial pressure. Measuring the client's head circumference is not the priority when there is a sudden increase in ventriculostomy drainage.

3. A male client with TB returns to the clinic for daily antibiotic injections for a urinary infection. The client has been taking anti-tubercular medications for 10 weeks and states he has ringing in his ears. Which prescribed medication should the PN report to the HCP?

• A. Pyridoxine with a B complex multivitamin
• B. Gentamicin 160 mg IM daily
• C. Rifampin 600 mg PO daily
• D. Isoniazid 300 mg PO daily

Correct answer: B

Rationale: The correct answer is B: Gentamicin 160 mg IM daily. Gentamicin is an aminoglycoside antibiotic that can cause ototoxicity, leading to ringing in the ears (tinnitus). This symptom should be reported to the HCP immediately, as it may indicate a need to adjust or discontinue the medication. Choice A, Pyridoxine with a B complex multivitamin, is not the cause of ototoxicity. Choices C and D, Rifampin and Isoniazid, are anti-tubercular medications but are not associated with causing ringing in the ears.

4. During a fire incident in a long-term care facility's kitchen, which task is most crucial for the PN to perform instead of delegating to UAP?

• A. Close the doors to all residents' rooms
• B. Offer comfort and reassurance to each resident
• C. Identify the method for transporting and evacuating each resident
• D. Provide blankets to each resident for use during evacuation

Correct answer: C

Rationale: During a fire emergency, the most critical task for the PN is to identify the method for transporting and evacuating each resident. This task ensures a safe and organized evacuation plan, which is essential for everyone's safety. Delegating this responsibility to an unlicensed assistive personnel (UAP) may lead to errors or delays in the evacuation process. Closing doors to residents' rooms (Choice A) can help contain the fire but is not as urgent as planning the evacuation. While offering comfort and reassurance (Choice B) is important, it should not take precedence over ensuring a safe evacuation. Providing blankets (Choice D) is helpful but does not directly address the primary concern of safely evacuating residents.

5. What is the most effective method to prevent medication errors during administration?

• A. Relying on memory for medication dosages
• B. Using a bar-code medication administration system
• C. Administering medications as quickly as possible to avoid delays
• D. Allowing another individual to administer medications

Correct answer: B

Rationale: Using a bar-code medication administration system is the best method to prevent medication errors during administration. This system verifies medication details electronically, ensuring that the correct medication is given to the right patient. Relying on memory for medication dosages (choice A) is not recommended as it can lead to errors. Administering medications quickly (choice C) may increase the risk of mistakes due to haste. Allowing another individual (choice D) to administer medications does not address the root cause of preventing errors during administration.

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