Nursing Elites

1. To reduce staff nurse role ambiguity, which strategy should the nurse-manager implement?

• A. Review the staff nurse job description to ensure that it is clear, accurate, and current.
• B. Conduct regular meetings to clarify roles.
• C. Increase communication between team members.
• D. Provide additional training for new nurses.

Correct answer: A

Rationale: The correct answer is A: Review the staff nurse job description to ensure that it is clear, accurate, and current. By ensuring that job descriptions are clear and up-to-date, nurse-managers can reduce ambiguity and confusion about roles and responsibilities. Choice B, conducting regular meetings to clarify roles, may help but may not address the root cause of ambiguity. Choice C, increasing communication between team members, is important but may not specifically target role ambiguity. Choice D, providing additional training for new nurses, is valuable but may not directly address role ambiguity among existing staff.

2. A client with cirrhosis is admitted with hepatic encephalopathy. Which laboratory value is most concerning?

• A. Serum ammonia level of 100 mcg/dl
• B. Bilirubin level of 3.0 mg/dl
• C. Prothrombin time of 18 seconds
• D. Serum sodium level of 135 mEq/L

Correct answer: A

Rationale: A serum ammonia level of 100 mcg/dl is most concerning in a client with hepatic encephalopathy. Elevated serum ammonia levels indicate significant liver dysfunction and an increased risk of worsening encephalopathy. Bilirubin level and prothrombin time are important in assessing liver function, but in the context of hepatic encephalopathy, elevated ammonia levels take precedence as they directly contribute to neurological symptoms. Serum sodium level, though important, is not the primary concern when managing hepatic encephalopathy.

3. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which clinical finding requires immediate intervention?

• A. Fever of 100.4°F
• B. Heart rate of 110 beats per minute
• C. Blood pressure of 140/90 mmHg
• D. Respiratory rate of 24 breaths per minute

Correct answer: A

Rationale: A fever of 100.4°F is a clinical finding that requires immediate intervention in a client with ESRD scheduled for hemodialysis. Fever may indicate an underlying infection, which can be severe in individuals with compromised renal function. Prompt assessment and treatment are essential to prevent worsening of the infection and potential complications. Heart rate, blood pressure, and respiratory rate are also important parameters to monitor in clients with ESRD, but in this scenario, the fever takes precedence due to its potential to indicate a critical condition that requires urgent attention.

4. A client is admitted with a diagnosis of pneumonia and is receiving IV antibiotics. Which assessment finding indicates that the treatment is effective?

• A. Client reports less chest pain.
• B. Client's white blood cell count is decreasing.
• C. Client has a decreased respiratory rate.
• D. Client has clear breath sounds.

Correct answer: D

Rationale: The correct answer is D. Clear breath sounds indicate that the pneumonia is resolving and the treatment is effective. Breath sounds are often muffled or crackling in pneumonia due to the presence of fluid or inflammation in the lungs. Clear breath sounds suggest that the air is moving freely through the lungs, indicating improvement. Choices A, B, and C are less specific indicators of pneumonia resolution. While less chest pain and a decreasing white blood cell count can be positive signs, they are not as direct in indicating the effectiveness of pneumonia treatment as the presence of clear breath sounds. A decreased respiratory rate could be seen in various conditions and may not solely indicate the resolution of pneumonia.

5. A client with heart failure is prescribed furosemide (Lasix). Which assessment finding should the nurse report to the healthcare provider immediately?

• A. Heart rate of 60 beats per minute
• B. Blood pressure of 100/60 mmHg
• C. Presence of a new murmur
• D. Crackles in the lungs

Correct answer: D

Rationale: The correct answer is D: Crackles in the lungs. Crackles indicate fluid overload in the lungs, a critical sign in a client with heart failure. This finding suggests that the furosemide may not be effectively managing the fluid balance, and immediate intervention is required. Choices A, B, and C are not immediate concerns in this scenario. A heart rate of 60 beats per minute, a blood pressure of 100/60 mmHg, and the presence of a new murmur are findings that may require monitoring or intervention but are not as urgent as crackles in the lungs in a client with heart failure.

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