Nursing Elites

1. A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?

• A. Withhold the benzodiazepine but continue the opioid
• B. Contact the provider about replacing the opioid with an NSAID
• C. Administer the benzodiazepine but withhold the opioid
• D. Continue the medication dosages that relieve the client's pain

Correct answer: B

Rationale: The correct action for the nurse to take is to contact the provider about replacing the opioid with an NSAID. In this scenario, the client is experiencing excessive sedation after the administration of both opioid and benzodiazepine. Switching to a non-opioid analgesic like an NSAID can help manage pain effectively without causing additional sedation. Option A is incorrect because continuing the opioid may exacerbate sedation. Option C is incorrect as administering the benzodiazepine may further increase sedation. Option D is incorrect because maintaining the current medication dosages that are causing excessive sedation is not in the client's best interest.

2. While caring for a four-year-old female patient who was severely burned in a house fire, how would you determine the extent of this child's burns?

• A. By using the Lund and Browder chart
• B. By using the Rule of Nines
• C. By using the Rule of Tens
• D. By using the Parkland Formula

Correct answer: A

Rationale: The correct answer is A: By using the Lund and Browder chart. The Lund and Browder chart is specifically designed to assess the extent of burns in children accurately, taking into account the variation in body proportions as children grow. This method provides a more precise estimation of the total body surface area affected by burns in pediatric patients. Choices B, C, and D are incorrect. The Rule of Nines is more suitable for adults, not children. The Rule of Tens is not a standard method for assessing burn extent, and the Parkland Formula is used to calculate fluid resuscitation requirements in burn patients, not to determine the extent of burns.

3. Nurses on an inpatient care unit are working to help reduce unit costs. Which of the following actions is appropriate to include in the cost-containment plan?

• A. Store opened bottles of normal saline in a refrigerator for up to 48 hours.
• B. Return unused supplies from the bedside to the unit's supply stock.
• C. Wait to dispose of sharps containers until they are completely full.
• D. Use clean gloves rather than sterile gloves for colostomy care.

Correct answer: D

Rationale: Using clean gloves rather than sterile gloves for colostomy care is a cost-effective measure without compromising care quality. This choice helps in reducing costs without compromising patient safety. Storing opened bottles of normal saline in a refrigerator for up to 48 hours (Choice A) may lead to contamination risks. Returning unused supplies to the unit's supply stock (Choice B) can be inefficient and lead to potential waste. Waiting to dispose of sharps containers until they are completely full (Choice C) may pose safety hazards and not directly impact cost savings.

4. A patient's serum potassium level is 2.2 mEq/L. Which nursing action is the highest priority for this patient?

• A. Start oxygen at 2 L/min
• B. Initiate cardiac monitoring
• C. Initiate seizure precautions
• D. Keep the patient on bed rest

Correct answer: B

Rationale: The correct answer is to initiate cardiac monitoring. Severe hypokalemia can lead to life-threatening arrhythmias, making cardiac monitoring the priority to detect and manage any cardiac complications. Starting oxygen, seizure precautions, or bed rest are not the immediate priority actions for severe hypokalemia.

5. A nurse in the emergency department is preparing to care for a client who arrived via ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following actions should the nurse take?

• A. Proceed with treatment without obtaining written consent
• B. Contact the client's next of kin to obtain consent for treatment
• C. Have the client sign a consent for treatment
• D. Notify risk management before initiating treatment

Correct answer: A

Rationale: In emergency situations where a client is disoriented and has a cardiac arrhythmia, obtaining written consent may not be possible due to the urgency of the situation. The priority is to provide immediate treatment to ensure patient safety. Contacting the next of kin or having the client sign a consent form would cause unnecessary delays in providing critical care. Notifying risk management before initiating treatment is not the most appropriate action when dealing with a time-sensitive situation like a cardiac arrhythmia.

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