Nursing Elites

1. Prior to a cardiac catheterization, what is the most important action for the nurse to take?

• A. Ensure that the client has been NPO for 6 hours before the procedure.
• B. Administer pre-procedure medications as ordered.
• C. Verify that informed consent has been obtained.
• D. Assess the client for any allergies, especially to iodine or shellfish.

Correct answer: D

Rationale: Assessing the client for allergies, particularly to iodine or shellfish, is crucial before a cardiac catheterization because the contrast dye used during the procedure can lead to allergic reactions. Identifying any allergies beforehand allows the healthcare team to take necessary precautions to prevent potential adverse reactions and ensure the client's safety.

2. A healthcare professional is auscultating the lungs of a client who has pleurisy. Which of the following adventitious breath sounds should the professional expect to hear?

• A. Loud, scratchy sounds
• B. Squeaky, musical sounds
• C. Popping sounds
• D. Snoring sounds

Correct answer: A

Rationale: When auscultating the lungs of a client with pleurisy, the healthcare professional should expect to hear loud, scratchy sounds. These sounds are characteristic of pleurisy, which is an inflammation of the pleura, causing a rough, grating sound during breathing.

3. After an open lung biopsy, a nurse assesses a client. Which assessment finding is matched with the correct intervention?

• A. Client states he is dizzy. Nurse applies oxygen and pulse oximetry.
• B. Client's HR is 55 beats/min. Nurse withholds pain medication.
• C. Client has reduced breath sounds. Nurse calls the physician immediately.
• D. Client's RR is 18 breaths/min. Nurse decreases the oxygen flow rate.

Correct answer: C

Rationale: After an open lung biopsy, a potential complication is pneumothorax, often indicated by reduced or absent breath sounds. The nurse should promptly notify the physician to address this serious issue and ensure timely intervention.

4. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest levels of competency. Which areas should the manager assess to determine if the nursing staff demonstrate competency according to the Institute of Medicine (IOM) report Health Professions Education: A Bridge to Quality? (Select ONE that does not apply)

• A. Collaborating with an interdisciplinary team
• B. Implementing evidence-based care
• C. Providing family-focused care
• D. Experimenting on patients

Correct answer: D

Rationale: The Institute of Medicine (IOM) report 'Health Professions Education: A Bridge to Quality' outlines five core competencies that healthcare providers should possess. These competencies include collaborating with an interdisciplinary team, implementing evidence-based care, providing family-focused care, using informatics in practice, and focusing on patient-centered care. Therefore, to ensure that nurses are practicing at their highest levels of competency as per the IOM report, the nurse manager should assess all of these areas.

5. A client with a spinal cord injury at T6 suddenly reports a pounding headache and blurred vision. What action should the nurse take first?

• A. Administer pain medication as ordered.
• B. Check the client's blood pressure.
• C. Place the client in a supine position.
• D. Increase the client's fluid intake.

Correct answer: B

Rationale: The client's symptoms of a pounding headache and blurred vision are indicative of autonomic dysreflexia, a potentially life-threatening condition in clients with spinal cord injuries at T6 or above. The nurse's priority action should be to check the client's blood pressure as autonomic dysreflexia can lead to severe hypertension. Identifying and addressing this elevated blood pressure promptly is crucial to prevent serious complications such as seizures, stroke, or even death. Once the blood pressure is assessed and managed, further interventions can be implemented to address the underlying cause of autonomic dysreflexia.

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