Nursing Elites

1. A healthcare professional is administering 1 L of 0.9% sodium chloride to a client who is postoperative and has fluid volume deficit. Which of the following changes should the healthcare professional identify as an indication that the treatment was successful?

• A. Increase in hematocrit
• B. Increase in respiratory rate
• C. Decrease in heart rate
• D. Decrease in capillary refill time

Correct answer: D

Rationale: The correct answer is D: Decrease in capillary refill time. In a client with fluid volume deficit, improving capillary refill time indicates that the perfusion status is improving due to the increase in fluid volume. Choices A, B, and C are incorrect. An increase in hematocrit may indicate hemoconcentration due to fluid loss, an increase in respiratory rate may suggest respiratory distress, and a decrease in heart rate may not be directly related to fluid volume status.

2. A unit director at a local hospital knows even leadership may face ethical dilemmas. Which of the following should the director take into consideration when dealing with an employee who is incompetent?

• A. The situation should be tolerated for as long as possible because of the amount of time and paperwork required to terminate an incompetent nurse.
• B. Incompetence only impacts the individual nurse.
• C. The director should follow her institution�s formal process for reporting and handling practices that jeopardize patient safety.
• D. Most nurse practice acts direct how to handle incompetent nurses.

Correct answer: C

Rationale: Incompetence jeopardizes patient safety. Therefore, the formal process for handling these practices should be followed.

3. The time period to give as notice for an appraisal is:

• A. One day.
• B. None.
• C. One week.
• D. Two days.

Correct answer: D

Rationale: The correct answer is D: 'Two days.' It is preferable to give two days' notice for a performance appraisal. Giving only one day's notice (Choice A) might not provide sufficient time for the employee to prepare adequately for the appraisal. Choice B, 'None,' is incorrect because it is essential to give advance notice for an appraisal to allow the employee time to get ready. Choice C, 'One week,' is too long of a notice period for a standard performance appraisal and could lead to unnecessary delays.

4. A recent nursing school graduate is preparing to take the NCLEX. The graduate knows which of the following is true?

• A. Upon graduation from nursing school, she cannot use the title RN.
• B. Because the NCLEX is a national examination, her RN license will allow her to practice in all states and territories of the United States.
• C. If her home state participates in the compact agreement, she may practice in other states participating in the agreement, but should renew her license in her home state.
• D. The RN license is a mandatory license.

Correct answer: C

Rationale: Choice C is correct because if the nurse's home state participates in the compact agreement, she can practice in other states that are part of the agreement, but she must still renew her license in her home state. This is necessary to maintain an active license in her home state. Choice A is incorrect because upon graduation, the nurse can use the title RN if licensed, but it's not automatic. Choice B is incorrect because while the NCLEX is a national exam, the nurse needs to meet individual state requirements for licensure in each state. Choice D is incorrect because an RN license is not permissive but rather a mandatory license to practice nursing.

5. Which of the following should be included in a discussion of advance directives with new nurse graduates?

• A. According to the Patient Self-Determination Act, nurses are required to inform clients of their right to create an advance directive.
• B. The advance directive designates an individual who will make financial decisions for the client if he or she is unable to do so.
• C. A living will designates who will make health-care decisions for an individual in the event the individual is unable or incompetent to make his or her own decisions.
• D. The advance directive designates a health-care surrogate who will make known the client�s wishes regarding medical treatment if the client is unable to do so.

Correct answer: A

Rationale: According to the Patient Self-Determination Act, nurses are required to inform clients of their right to create an advance directive.

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