Nursing Elites

1. Which sign might a healthcare professional observe in a client with a high ammonia level?

• A. coma
• B. edema
• C. hypoxia
• D. polyuria

Correct answer: A

Rationale: A high ammonia level can lead to hepatic encephalopathy, which includes symptoms like confusion, disorientation, and can progress to coma. Coma is a severe condition of unconsciousness. Edema is swelling caused by excess fluid trapped in body tissues, not typically associated with high ammonia levels. Hypoxia is a condition of inadequate oxygen supply to tissues and organs, not directly related to high ammonia levels. Polyuria is excessive urination, which is not a typical sign of high ammonia levels.

2. A health care provider writes a medication prescription in a client's record. While transcribing the prescription, the nurse notes that the prescribed dose is three times higher than the recommended dose. The nurse calls the health care provider, who states that this is the dose that the client takes at home and that it is acceptable for this client's condition. What is the appropriate action for the nurse to take?

• A. Verifying the prescribed dose with the client before administering the medication
• B. Contacting the nursing supervisor
• C. Asking the nurse assigned to care for the client to administer the medication
• D. Continuing to transcribe the prescription

Correct answer: B

Rationale: In this scenario, the nurse has identified a significant discrepancy between the prescribed dose and the recommended dose. While the health care provider has justified the higher dose based on the client's home regimen, the nurse's primary responsibility is to ensure patient safety. If a nurse has concerns about a prescription being incorrect or potentially harmful, they should seek further clarification from the health care provider. Since the nurse still believes the dose is inappropriate after discussing with the health care provider, the next appropriate action is to contact the nursing supervisor. Continuing to transcribe the prescription without addressing the concern could jeopardize the client's safety. Asking another nurse to administer the medication without proper resolution of the dosage concern would also pose a risk to the client. While verifying the prescribed dose with the client is important, in this situation, the nurse should first escalate the issue to the nursing supervisor to ensure appropriate actions are taken.

3. A nurse is supervising a new nursing graduate in various procedures. Which action by the new nursing graduate constitutes a negligent act?

• A. Giving a verbal report to the nurse on the oncoming shift
• B. Checking neurological signs in a client with a head injury
• C. Contacting a healthcare provider about a change in a client's blood pressure
• D. Using clean gloves to change a gastrostomy tube dressing

Correct answer: D

Rationale: Negligent acts in nursing include various errors that can harm the client, such as medication errors, intravenous therapy errors, burns, falls, failure to use aseptic technique, failure to provide adequate monitoring, and failure to report significant changes in a client's condition. In this scenario, using clean gloves to change a gastrostomy tube dressing is a negligent act because sterile gloves should be used when changing a dressing over broken skin. Choices A, B, and C are not negligent acts as they involve appropriate nursing actions: giving a verbal report, checking neurological signs, and contacting a healthcare provider about a change in a client's blood pressure.

4. A case manager is reviewing notations made in clients' records. Which note indicates an unexpected outcome and the need for immediate follow-up?

• A. A client who exhibits signs of increased intracranial pressure after a craniotomy.
• B. A client who has sustained a stroke and dresses herself.
• C. A client with a spinal cord injury transfers himself from a bed to a wheelchair.
• D. Normal neurological findings are noted in a client with a cerebral aneurysm.

Correct answer: A

Rationale: A case manager is responsible for coordinating a client's care and monitoring for unexpected outcomes. The situation that indicates an unexpected outcome and the need for immediate follow-up is when a client exhibits signs of increased intracranial pressure after a craniotomy. This indicates a deteriorating condition that requires urgent intervention. Choices B, C, and D describe expected outcomes or normal findings related to specific conditions, which do not demand immediate follow-up.

5. Nonpharmacological pain management involves all of the following except:

• A. hypnosis alone.
• B. psychological care, including support groups.
• C. physical and psychological modalities.
• D. pain-reducing drugs only.

Correct answer: D

Rationale: Nonpharmacological pain management encompasses various strategies like hypnosis, psychological care, and physical and psychological modalities. The correct answer is 'pain-reducing drugs only' because nonpharmacological approaches do not solely rely on medications for pain management. Options A, B, and C are all valid components of nonpharmacological pain management. Hypnosis can help manage pain, psychological care including support groups can provide emotional support and coping strategies, and physical and psychological modalities encompass a wide range of interventions beyond just medication.

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