Nursing Elites

1. A client with antisocial personality disorder repeatedly requests a specific nurse be assigned to him and is belligerent when another nurse is assigned. What action should the charge nurse implement?

• A. Remind the client that nurse assignments are not based on patient requests
• B. Assign the nurse requested by the client to avoid further conflict
• C. Tell the client that he can request a different nurse if unhappy
• D. Explain the situation calmly and reinforce the rules regarding nurse assignments

Correct answer: A

Rationale: The correct action for the charge nurse to implement is to remind the client that nurse assignments are not based on patient requests. In this situation, it is essential to establish boundaries and communicate that nurse assignments are made based on clinical decisions, not patient preferences. Option B is incorrect because it compromises the principle of fairness in nurse assignments. Option C is incorrect as it encourages the client's behavior by allowing him to request a different nurse based on personal preferences. Option D is also incorrect as it does not address the issue of patient manipulation and reinforces inappropriate behavior.

2. The nurse is caring for a client with pancreatitis who is receiving total parenteral nutrition (TPN). Which assessment finding requires immediate intervention by the nurse?

• A. Blood glucose level of 200 mg/dL
• B. The client reports feeling weak and shaky
• C. The TPN bag is 5% dextrose
• D. The client reports feeling thirsty

Correct answer: B

Rationale: The correct answer is B. Weakness and shakiness can indicate hypoglycemia, a potential complication of TPN. Immediate intervention is necessary to assess blood glucose levels and provide treatment as needed. Choice A is incorrect because a blood glucose level of 200 mg/dL is within an acceptable range and does not require immediate intervention. Choice C is incorrect as a 5% dextrose TPN bag is a standard concentration. Choice D is also incorrect as feeling thirsty is not a critical assessment finding requiring immediate intervention in this context.

3. A client at 12 weeks gestation is admitted to the antepartum unit with a diagnosis of hyperemesis gravidarum. Which action is most important for the nurse to implement?

• A. Provide emotional support
• B. Monitor daily weight
• C. Encourage small frequent meals
• D. Initiate prescribed intravenous fluids

Correct answer: D

Rationale: Hyperemesis gravidarum, characterized by severe nausea and vomiting, leads to dehydration and electrolyte imbalances. The priority intervention is initiating IV fluids to correct these imbalances. Providing emotional support is important for the client's well-being, but addressing fluid and electrolyte imbalances takes precedence. Monitoring daily weight and encouraging small frequent meals are beneficial interventions but are not the priority when managing hyperemesis gravidarum.

4. Following a cardiac catheterization and placement of a stent in the right coronary artery, the nurse administers prasugrel, a platelet inhibitor, to the client. To monitor for adverse effects from the medication, which assessment is most important for the nurse to include in this client's care plan?

• A. Check platelet count
• B. Observe the color of urine
• C. Review liver function tests
• D. Monitor for bleeding

Correct answer: D

Rationale: Prasugrel is a platelet inhibitor, which increases the risk of bleeding. Monitoring for bleeding, particularly at the catheterization site and in other areas, is the most important assessment following administration of the drug. Checking platelet count and observing urine color are relevant but not as immediate. Reviewing liver function tests is not directly related to the adverse effects of prasugrel.

5. A client with cirrhosis is at risk for bleeding due to impaired liver function. Which laboratory result is the most important to monitor?

• A. Blood urea nitrogen (BUN)
• B. Prothrombin time (PT)
• C. Aspartate aminotransferase (AST)
• D. Serum albumin

Correct answer: B

Rationale: Prothrombin time (PT) measures the time it takes for blood to clot and is a critical indicator of bleeding risk in clients with liver dysfunction. Impaired liver function reduces clotting factor production, leading to an increased PT, which requires close monitoring. Monitoring BUN (Choice A) is more indicative of kidney function, not clotting ability. Aspartate aminotransferase (AST) (Choice C) and serum albumin (Choice D) are important indicators of liver function, but they do not directly assess the client's bleeding risk.

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