Nursing Elites

1. Which nursing intervention is most appropriate to maintain the patency of a client's nasogastric tube?

• A. Maintain a constant connection to low-intermittent suction
• B. Irrigate the tube as per physician's order
• C. Suction the mouth and nose every shift
• D. Perform a daily fecal occult blood sample

Correct answer: B

Rationale: The correct answer is to irrigate the tube as per physician's order. A client with a nasogastric tube is at risk of the tube kinking or clotting off, which can lead to complications such as abdominal distention or vomiting. To ensure the patency of the tube, the nurse should follow the physician's orders and facility policy to irrigate the tube with water or a solution as needed. Maintaining a constant connection to low-intermittent suction (Choice A) is not typically done to maintain tube patency. Suctioning the mouth and nose every shift (Choice C) is not directly related to maintaining nasogastric tube patency. Performing a daily fecal occult blood sample (Choice D) is unrelated to maintaining the patency of a nasogastric tube.

2. A family member is complaining that the lights are too dim in the middle of the night when she comes in to visit her husband. What is the most objective response?

• A. Patients sleep better with the lights dimmed.
• B. The nightshift nurses prefer to work with less light.
• C. It's time for him to sleep, and you should, too.
• D. There's a reason we do that. Let me share a research study with you.

Correct answer: D

Rationale: The most objective response in this situation is to explain to the family member that there is a specific reason for dimming the lights and offer to share a research study to provide evidence-based information. By doing so, it helps the family member understand that the care provided is based on established practices and research, potentially alleviating her concerns and ensuring that her husband receives appropriate care. Choices A, B, and C do not address the family member's concern or provide a rationale backed by evidence, making them less suitable responses in this context.

3. As a nurse, you have been assigned to take over as charge nurse without any report after the previous charge nurse fell during her shift and was taken to the emergency room. At the end of the shift, you have made the assignments for the next shift's nurses and posted them. As the nurses come in, they begin to complain that the assignments make no sense based on patient acuity. One refuses to take her assignment and threatens to go home. What could you have done to prevent their dissatisfaction?

• A. Reviewed the notes of the previous charge nurse
• B. Tried to contact the previous charge nurse in the emergency room
• C. Collaborated with the nurse manager
• D. Collaborated with the other nurses on your shift

Correct answer: D

Rationale: Collaborating with the other nurses on your shift would have permitted them to provide the most updated information regarding patient status and acuity. Requesting their input into creating assignments would have provided shared governance and assurance that the unit staffing was arranged appropriately. Reviewing the notes of the previous charge nurse might not capture the real-time changes in patient conditions. Trying to contact the previous charge nurse in the emergency room may not be feasible or timely. Collaborating with the nurse manager could be helpful, but involving the nurses directly impacted by the assignments would have been more effective in addressing their concerns and ensuring appropriate patient care.

4. Which of the following reasons would be legal when considering a patient's medical record?

• A. Allowing a patient's brother to view her chart to find out her birthdate and address so that he can mail her a card
• B. Not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing
• C. Not allowing a patient to view her chart because she is behind on her payments
• D. All of the above are legal

Correct answer: B

Rationale: The correct answer is not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing. Physicians have a duty to withhold certain health information from patients if disclosing it could potentially harm the patient. In situations where revealing certain information may have a significantly negative impact on the patient's mental or physical health, healthcare providers have the legal right to withhold that information. Allowing a patient's brother to view her chart for non-medical reasons like sending a card is not a valid legal reason for disclosing patient information. Similarly, refusing access based on financial reasons is not a legal ground for restricting access to a patient's medical record as patient care should not be influenced by financial matters.

5. A patient with Addison's disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is not recommended?

• A. A diet high in grains
• B. A diet with adequate caloric intake
• C. A high protein diet
• D. A restricted sodium diet

Correct answer: D

Rationale: For a patient with Addison's disease, a restricted sodium diet is not recommended. These patients require normal dietary sodium to prevent excess fluid loss. Patients with primary adrenal insufficiency (Addison disease) should have ample access to salt because of the salt wasting that occurs if their condition is untreated. Therefore, a diet high in grains, a diet with adequate caloric intake, and a high protein diet are all recommended for patients with Addison's disease to support their nutritional needs and overall health. However, restricting sodium can be detrimental for these patients due to the nature of their condition.

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