Nursing Elites

1. When assessing a client with terminal cancer receiving a continuous intravenous infusion of morphine sulfate, what should the nurse check first?

• A. Temperature
• B. Respiratory status
• C. Pulse
• D. Urine output

Correct answer: B

Rationale: When assessing a client with terminal cancer receiving morphine sulfate via continuous intravenous infusion, the nurse's priority should be checking the client's respiratory status first. Morphine sulfate can lead to respiratory depression, emphasizing the need for close monitoring of breathing. While temperature, pulse, and urine output are all essential components of the assessment, ensuring adequate respiratory function takes precedence due to the potential risk of respiratory depression associated with morphine sulfate. Promptly assessing respiratory status enables early identification of any signs of respiratory distress or depression, allowing for immediate intervention if needed.

2. A nurse manager asks a nurse to work overtime because of a short-staffing problem. The nurse has made plans to do Christmas shopping after work and does not want to work overtime. What is the most assertive response by the nurse to her nurse manager?

• A. "I'm not working overtime today."
• B. "I have plans after work and will not be able to work overtime."
• C. "You know how I hate to work overtime."
• D. "I will if you need me, but I am not happy about this."

Correct answer: B

Rationale: The most assertive response in dealing with this conflict is the one that is direct and conveys a clear message in a positive manner. The nurse should assertively communicate her unavailability for overtime without being confrontational. Option A, "I'm not working overtime today," is too blunt and may come across as rude. Option C, "You know how I hate to work overtime," is not assertive but rather passive-aggressive. Option D, "I will if you need me, but I am not happy about this," is a passive-aggressive response as it implies compliance while expressing discontent. Option B, "I have plans after work and will not be able to work overtime," is the most appropriate response as it clearly states the nurse's unavailability without unnecessary aggression.

3. The nurse is transferring a client from a wheelchair to the bed. Which is the correct procedure?

• A. Pull the client toward you, and pivot him on the unaffected limb.
• B. Pull the client toward you, and pivot him on the affected limb.
• C. Push the client toward the bed, and pivot him on the affected limb.
• D. Stand the client on both legs, and push him toward the bed.

Correct answer: A

Rationale: When transferring a client from a wheelchair to the bed, the correct procedure is to pull the client toward you, which reduces workload force. By pivoting the client on the unaffected limb, strength is maintained to support the affected limb while moving towards the bed. Choice A is correct because it ensures a safe and effective transfer technique. Choices B, C, and D are incorrect as they involve incorrect positioning and movements that could potentially harm the client or increase the risk of injury. Pulling the client towards you puts less strain on your back and reduces the risk of injury. Pivoting on the unaffected limb ensures better support for the client's affected limb during the transfer process.

4. A client with which of the following conditions is at risk for developing a high ammonia level?

• A. renal failure
• B. psoriasis
• C. lupus
• D. cirrhosis

Correct answer: D

Rationale: A client with cirrhosis is at risk for developing a high ammonia level due to impaired liver function. The liver normally converts ammonia into urea for excretion. In cirrhosis, this process is compromised, leading to elevated ammonia levels in the blood. Renal failure, psoriasis, and lupus do not typically cause high ammonia levels. Renal failure affects kidney function, while psoriasis and lupus are autoimmune conditions that do not directly impact ammonia metabolism.

5. A case management clinical pathway for congestive heart failure might include all of the following except:

• A. physician follow-up appointments with transportation
• B. client education regarding medication use
• C. a nutritional consult for diet review and accommodation
• D. insurance review for reimbursement

Correct answer: D

Rationale: In a case management clinical pathway for congestive heart failure, the focus is on providing medical care and support to the patient. Choices A, B, and C are integral parts of managing congestive heart failure. Physician follow-up appointments with transportation ensure continuity of care, client education about medication use is crucial for adherence, and a nutritional consult helps in managing the patient's diet. However, insurance review for reimbursement is not typically part of the clinical pathway as it pertains to financial aspects and is usually handled by billing departments or external agencies. Therefore, the correct answer is 'insurance review for reimbursement.'

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