Nursing Elites

1. A group of nurses implemented a pilot study to evaluate a proposed evidence-based change to providing client care. Evaluation indicates successful outcomes, and the nurses want to integrate the change throughout the facility. Which action should be taken? (Select all that apply)

• A. Invite data review by the quality improvement department
• B. Submit a sentinel event report to the research committee
• C. Propose clinical practice guidelines to the nursing committee
• D. Arrange in-service training through the educational department

Correct answer: A

Rationale: Inviting data review by the quality improvement department is crucial to ensure the quality and efficacy of the proposed evidence-based change. This step allows for a comprehensive analysis of the data collected during the pilot study. Proposing clinical practice guidelines to the nursing committee is also essential for integrating the successful change into routine practice. In-service training through the educational department will help educate staff and ensure they are proficient in implementing the new practices. Submitting a sentinel event report to the research committee is not necessary in this scenario as the outcomes were successful, and there were no adverse events that would warrant such a report. Choices B, C, and D are not as relevant in this context compared to inviting data review by the quality improvement department, which is a crucial step in ensuring the success of the proposed change.

2. After a client with leukemia undergoes a bone marrow biopsy and is found to have thrombocytopenia, which nursing assessment is most important following the procedure?

• A. Observe the aspiration site
• B. Assess body temperature
• C. Monitor skin elasticity
• D. Measure urinary output

Correct answer: A

Rationale: The correct answer is to observe the aspiration site. Thrombocytopenia, characterized by a low platelet count, increases the risk of bleeding. Therefore, monitoring the biopsy site for bleeding or hematoma is crucial to ensure early detection and intervention. Assessing body temperature (choice B) is not directly related to the increased bleeding risk associated with thrombocytopenia. Monitoring skin elasticity (choice C) and measuring urinary output (choice D) are important assessments but are not the priority in this situation where bleeding risk needs immediate attention.

3. What is the best response when a two-year-old boy begins to cry when his mother starts to leave?

• A. Say, 'Let's wave bye-bye to Mommy.'
• B. Say, 'Let me read this book to you.'
• C. Say, 'Two-year-olds usually stop crying the minute the parent leaves.'
• D. Say, 'Now, now, be a big boy, Mommy will be back soon.'

Correct answer: B

Rationale: The best response in this situation is to offer a distraction to the child. Reading a book can help soothe the child during separation from the parent by redirecting their attention. Choice A might not be as effective as providing a distraction like reading a book. Choice C dismisses the child's feelings and generalizes behavior, which is not helpful. Choice D diminishes the child's emotions and does not provide a constructive way to help the child cope with the separation anxiety.

4. A heparin infusion is prescribed for a client who weighs 220 pounds. After administering a bolus dose of 80 units/kg, the nurse calculates the infusion rate for the heparin sodium at 18 units/kg/hour. The available solution is Heparin Sodium 25,000 units in 5% Dextrose Injection 250 ml. The nurse should program the infusion pump to deliver how many ml/hour?

• A. 18
• B. 27
• C. 36
• D. 45

Correct answer: B

Rationale: To calculate the infusion rate, first, find the total dose required per hour, which is the patient's weight (220 pounds) multiplied by the prescribed rate (18 units/kg/hour). This equals 3960 units/hour. Next, determine how many ml of the solution contain 25,000 units; this is 250 ml. Divide the total dose required per hour (3960 units) by the units per ml (25,000 units/250 ml) to find how many ml are needed per hour. This results in 27 ml/hour. Therefore, the nurse should program the infusion pump to deliver 27 ml/hour. Choice A (18) is incorrect as it does not account for the concentration of the heparin solution. Choices C (36) and D (45) are incorrect as they do not reflect the accurate calculations based on the patient's weight and the heparin concentration in the solution.

5. Which client should the nurse assess frequently because of the risk for overflow incontinence?

• A. A client who is bedfast, with increased serum BUN and creatinine levels
• B. A client with hematuria and decreasing hemoglobin and hematocrit levels
• C. A client who has a history of frequent urinary tract infections
• D. A client who is confused and frequently forgets to go to the bathroom

Correct answer: A

Rationale: The correct answer is A. Bedfast clients with increased serum BUN and creatinine levels are at high risk for overflow incontinence. This occurs due to decreased bladder function and reduced ability to sense bladder fullness, leading to the bladder overfilling and leaking urine. Choice B describes symptoms related to possible urinary tract infections or renal issues, but these do not directly indicate overflow incontinence. Choice C, a history of frequent urinary tract infections, may suggest other urinary issues but not specifically overflow incontinence. Choice D, a confused client who forgets to go to the bathroom, is more indicative of functional incontinence rather than overflow incontinence.

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