Nursing Elites

1. A healthcare professional is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. Which of the following entries should the healthcare professional make in the medical record?

• A. Morphine 3 mg Subcutaneous every 4 hr. PRN for pain.
• B. Morphine 3 mg Subcutaneous
• C. Morphine 3.0 mg subcutaneously every 4 hr. PRN for pain.
• D. Morphine 3 mg Subcutaneous q 4 hr. PRN for pain.

Correct answer: D

Rationale: The correct entry for documenting the prescription for morphine is 'Morphine 3 mg Subcutaneous'. This entry accurately specifies the medication, dosage, route of administration, and frequency as prescribed by the provider. Options A, C, and D contain minor errors such as missing units of measurement or incorrect abbreviations, which could lead to misinterpretation or potential medication errors. Therefore, the most appropriate and accurate choice is 'Morphine 3 mg Subcutaneous'.

2. During the removal of a chest tube, what should the nurse instruct the client to do?

• A. Lie on their left side.
• B. Use the incentive spirometer.
• C. Cough at regular intervals.
• D. Perform the Valsalva maneuver.

Correct answer: D

Rationale: During the removal of a chest tube, instructing the client to perform the Valsalva maneuver is essential. This maneuver involves holding the breath and bearing down, which helps prevent air from entering the pleural space during tube removal, reducing the risk of pneumothorax. Instructing the client to lie on their left side, use the incentive spirometer, or cough at regular intervals is not appropriate during the chest tube removal process.

3. During a Romberg test, the patient is asked to assume which position?

• A. Sitting
• B. Standing
• C. Genupectoral
• D. Trendelenburg

Correct answer: B

Rationale: During a Romberg test, the patient is asked to stand with feet together and arms at the sides. The test evaluates proprioception and vestibular function by assessing the patient's ability to maintain balance with eyes closed. Asking the patient to stand helps to detect any balance issues or disturbances in the absence of visual input.

4. A nurse manager is reviewing documentation with a newly licensed nurse. Which of the following notations by the newly licensed nurse indicates an understanding of the teaching?

• A. ''OOB with assistance for breakfast''
• B. ''Given 2 mg MSO4 IM for report of pain''
• C. ''Dressing changed qd''
• D. ''Administered 8 units of regular insulin subcutaneously''

Correct answer: D

Rationale: The correct answer demonstrates proper documentation by specifying the action taken ('Administered'), the dose ('8 units'), the medication ('regular insulin'), and the route of administration ('subcutaneously'). This notation ensures clarity and accuracy in recording the nursing intervention, aligning with best practices in documentation.

5. When is sterile technique used?

• A. During strict isolation procedures
• B. After terminal disinfection is performed
• C. For invasive procedures
• D. When protective isolation is necessary

Correct answer: C

Rationale: Sterile technique is utilized during invasive procedures to prevent the introduction of pathogens, minimizing the risk of infections. This strict approach ensures that the procedure is performed in a sterile environment, reducing the chances of contamination and subsequent complications.

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