Nursing Elites

1. A client is leaving the hospital against medical advice (AMA) and voluntarily signs the AMA form. Which nursing action is essential prior to the client leaving?

• A. Remove the client's peripheral IV access
• B. Administer requested pain relief medication
• C. Obtain the client's neurological vital signs
• D. Provide the client with the hospital's phone number

Correct answer: A

Rationale: Removing the client's peripheral IV access is essential before the client leaves against medical advice to prevent complications such as infection, thrombosis, or bleeding. Administering pain relief medication (choice B) can be important but not essential at this point. Obtaining neurological vital signs (choice C) is not specifically required before the client leaves. Providing the client with the hospital's phone number (choice D) may be helpful but is not as essential as ensuring the safe removal of IV access.

2. The nurse is planning discharge teaching for a client with chronic kidney disease. Which information is most important for the nurse to provide this client?

• A. Monitor daily weights
• B. Limit fluid intake to prevent fluid overload
• C. Report any weight gain of more than 2 pounds in a day
• D. Increase protein intake to promote healing

Correct answer: C

Rationale: The most important information for the nurse to provide a client with chronic kidney disease is to report any weight gain of more than 2 pounds in a day. This is crucial because sudden weight gain can indicate fluid retention, which is a common issue in kidney disease. Monitoring daily weights, as in option A, is important but not as critical as reporting sudden weight gain. Option B, limiting fluid intake, is a general recommendation for kidney disease but not the most important aspect in this scenario. Option D, increasing protein intake, is not appropriate as excessive protein intake can be harmful for clients with kidney disease.

3. An experienced nurse tells the nurse-manager that working with a new graduate is impossible because the new graduate will not listen to suggestions. The new graduate comes to the nurse-manager describing the senior nurse's attitude as challenging and offensive. What action is best for the nurse manager to take?

• A. Have both nurses meet separately with the staff mental health consultant
• B. Listen actively to both nurses and offer suggestions to solve the dilemma
• C. Ask the senior nurse to examine mentoring strategies used with the new graduate
• D. Ask the nurses to meet with the nurse-manager to identify ways of working together

Correct answer: D

Rationale: Facilitating a meeting for the nurses to identify ways of working together is the best action for the nurse manager. This approach promotes open communication, collaboration, and allows both nurses to express their concerns and perspectives. Option A may not address the underlying issues between the nurses and involving a mental health consultant may not be necessary at this stage. Option B, while listening is important, may not fully resolve the conflict without a structured plan. Option C focuses solely on the senior nurse without involving the new graduate in resolving the situation.

4. Nurses working in labor and delivery are demanding a change in policy because they believe they are required to float more often than nurses on other units. However, floating to labor and delivery is not reciprocated because other nurses are not competent to provide highly specialized obstetrical skills. What action is best for the nurse-manager to implement?

• A. Require cross-training for obstetrics for other nurses
• B. Propose a method for self-staffing labor and delivery
• C. Remind nurses that floating is an administrative policy
• D. Encourage nurses to share their feelings with administration

Correct answer: B

Rationale: The best action for the nurse-manager to implement is to propose a method for self-staffing labor and delivery. This approach allows nurses to manage their schedules, ensuring a fair balance of workloads. Requiring cross-training for obstetrics for other nurses (Choice A) may not be feasible or necessary for all units. Reminding nurses that floating is an administrative policy (Choice C) does not address the underlying issue of workload balance. Encouraging nurses to share their feelings with administration (Choice D) may not lead to a concrete solution for the unequal floating concerns.

5. When obtaining an admission history for a client who is at 9 weeks gestation, the client states, 'I had a miscarriage 2 years ago.' Which information is most important for the nurse to obtain?

• A. How long was your previous pregnancy?
• B. How long did it take for you to become pregnant after your miscarriage?
• C. Was your miscarriage during the first trimester?
• D. Do you have any children now?

Correct answer: A

Rationale: The correct answer is A. Understanding the duration of the previous pregnancy helps assess the client's obstetric history. Choice B focuses on the time it took to conceive after the miscarriage, which is less relevant at this point. Choice C asks about the timing of the miscarriage rather than the duration of the previous pregnancy. Choice D inquires about the current status of having children, which is not directly related to the client's obstetric history.

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