Nursing Elites

1. A case manager is preparing a discharge plan for a client following coronary artery bypass grafting surgery. Which of the following client issues should the nurse address first?

• A. Inadequate food supply
• B. Low pain tolerance
• C. Limited social support
• D. Decreased self-esteem

Correct answer: A

Rationale: The nurse should address the inadequate food supply first as it directly impacts the client's health post-discharge. Proper nutrition is crucial for recovery after surgery, especially such as coronary artery bypass grafting. While low pain tolerance, limited social support, and decreased self-esteem are all important issues to address, addressing the client's nutritional needs is the priority in this scenario to ensure optimal recovery and healing.

2. Select the stage of viral hepatitis that is accurately paired with its characteristic(s).

• A. The prodromal stage: Jaundice begins
• B. The icteric stage: Flu-like symptoms occur
• C. The pre-icteric stage: Elevated urine bilirubin levels
• D. The post-icteric stage: Jaundice and dark urine occur

Correct answer: D

Rationale: The post-icteric stage of viral hepatitis is accurately described as the stage where jaundice and dark urine occur due to the accumulation of bilirubin. The resolution of jaundice and normalization of urine color are seen in this stage. Choices A, B, and C are incorrect. In the prodromal stage, symptoms like fatigue and malaise appear before jaundice. The icteric stage is characterized by jaundice, not flu-like symptoms. The pre-icteric stage does not typically involve elevated urine bilirubin levels, as this occurs after the icteric stage.

3. A client has a new diagnosis of chlamydia. Which of the following actions should the nurse take?

• A. Report the infection to the local health department
• B. Apply an antiviral cream to lesions
• C. Instruct the client to use condoms until the treatment is completed
• D. Initiate contact precautions

Correct answer: A

Rationale: The correct answer is to report the infection to the local health department. Chlamydia is a reportable disease, meaning healthcare providers are required to report cases to public health authorities for tracking and control measures. Choice B is incorrect because chlamydia is a bacterial infection, not a viral infection, so antiviral cream would not be effective. Choice C is important advice for preventing the spread of chlamydia but is not the priority in this scenario. Choice D is not necessary for chlamydia, as it is primarily transmitted through sexual contact.

4. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select one that does not apply.

• A. The nurse could have given the insulin subcutaneously.
• B. The nurse did not have to contact the physician.
• C. The nurse should have used regular insulin (Humulin R).
• D. The nurse used the correct insulin.

Correct answer: C

Rationale: The best evaluation of the nurse reveals that she should have used regular insulin (Humulin R) for IV administration. Regular insulin is the only insulin approved for intravenous administration due to its pharmacokinetic properties. Insulin lispro (Humalog) is not suitable for IV use. Choice A is incorrect because giving insulin intravenously is necessary in this case of high blood sugar. Choice B is incorrect because administering a different insulin without consulting the physician is not appropriate. Choice D is incorrect because the nurse used the incorrect insulin, which could pose risks to the client's health.

5. A nurse is comparing the rate of medication errors on the medical unit to the rate from a medical unit in a magnet hospital. Which of the following quality improvement methods is the nurse using?

• A. Structure audit
• B. Benchmarking
• C. Risk benefit analysis
• D. Root cause analysis

Correct answer: B

Rationale: The correct answer is B: Benchmarking. Benchmarking involves comparing performance metrics with those from other units or institutions, which is exactly what the nurse is doing by comparing the rate of medication errors on their medical unit to the rate from a medical unit in a magnet hospital. Choice A, Structure audit, is not relevant to this scenario as it focuses on assessing the physical, organizational, or procedural structures in a healthcare setting. Choice C, Risk benefit analysis, involves weighing the potential risks and benefits of a particular course of action, not comparing performance metrics. Choice D, Root cause analysis, is a method used to identify the underlying causes of problems or adverse events, not to compare performance metrics between units.

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