Nursing Elites

1. Which is an example of a sentinel event?

• A. The terminally ill client is referred to hospice and dies 3 months later.
• B. A client receives an unordered mammogram which reveals a small cyst.
• C. A client with a laceration to the knee requiring 4 sutures falls when getting up unassisted after being instructed to remain in bed.
• D. A client scheduled for knee replacement surgery had an above-the-knee amputation performed.

Correct answer: D

Rationale: Yes! A sentinel event is an unexpected occurrence causing death or serious injury. In this case, a client who was scheduled for knee replacement surgery but had an above-the-knee amputation performed instead represents a sentinel event as it resulted in serious harm that was not intended. The other choices do not meet the criteria for a sentinel event. Choice A describes a natural progression for a terminally ill client, choice B shows an incidental finding from a test, and choice C involves a preventable fall leading to an injury but not a sentinel event.

2. A nurse is assessing an 18-year-old female who has recently suffered a TBI. The nurse notes a slower pulse and impaired respiration. The nurse should report these findings immediately to the physician due to the possibility the patient is experiencing which of the following conditions?

• A. Increased intracranial pressure
• B. Increased function of cranial nerve X
• C. Sympathetic response to activity
• D. Meningitis

Correct answer: A

Rationale: The nurse should report the slower pulse and impaired respiration to the physician immediately as they are indicative of increased intracranial pressure (ICP) following a traumatic brain injury (TBI). These signs suggest that there may be a rise in pressure within the skull, which can be a life-threatening condition requiring urgent intervention. Options B and C are unlikely in this scenario as they do not correlate with the symptoms presented. Meningitis (Option D) typically presents with different signs and symptoms, such as fever, headache, and neck stiffness, which are not described in the patient's case.

3. A client has been receiving cyanocobalamin (B12) injections for the past 6 weeks. Which laboratory finding indicates that the medication is having the desired effect?

• A. Neutrophil count of 60%
• B. Basophil count of 0.5%
• C. Monocyte count of 2%
• D. Reticulocyte count of 1%

Correct answer: D

Rationale: Cyanocobalamin is a B12 medication used for pernicious anemia. A reticulocyte count of 1% indicates the desired effect of the medication, as reticulocytes are immature red blood cells that increase in response to B12 therapy, improving anemia. Neutrophils, basophils, and monocytes are white blood cells and are not directly influenced by B12 injections, making them incorrect choices.

4. Which physiologic mechanism best describes the function of the sodium-potassium pump?

• A. active transport
• B. diffusion
• C. filtration
• D. osmosis

Correct answer: A

Rationale: Active transport is the correct answer as it accurately describes the process involved in the sodium-potassium pump. The pump utilizes energy to move ions against their concentration gradient, maintaining cellular concentrations. Diffusion (choice B) is a passive process where substances move from an area of higher concentration to lower concentration. Filtration (choice C) involves the movement of solutes based on pressure gradients. Osmosis (choice D) is the movement of water across a semipermeable membrane.

5. What is appropriate care for a client with neutropenia?

• A. Avoiding fresh fruits and vegetables.
• B. Having a private room.
• C. Wearing a mask when out of the room.
• D. Practicing routine hand washing.

Correct answer: C

Rationale: When a client has neutropenia, they have low white blood cell levels, which increases the risk of infections due to a weakened immune system. Wearing a mask when out of the room is crucial to reduce the risk of exposure to respiratory infections. Avoiding fresh fruits and vegetables is also necessary as they may contain harmful pathogens. Having a private room helps minimize exposure to pathogens and ensures that visitors are carefully screened for any signs of illness. Routine hand washing is essential to prevent the spread of infections in the healthcare setting, but the most direct measure to protect the client from potential infections is wearing a mask when out of the room.

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