Nursing Elites

1. A nurse manager is preparing to complete staff performance appraisals. Which of the following principles should the nurse manager consider when completing the appraisals?

• A. Performance appraisals should be written in measurable terms
• B. Appraisal objectives should be applicable to staff at every level
• C. Performance appraisals should be based on the nurse manager's preferences
• D. Completed appraisals should be approved by a provider

Correct answer: A

Rationale: Corrected Rationale: Performance appraisals should indeed be written in measurable terms to ensure objective evaluations based on specific outcomes achieved. This allows for a clear assessment of staff performance. Choice B is incorrect because appraisal objectives should be tailored to each staff member's role and responsibilities, not necessarily applicable at every level. Choice C is incorrect as performance appraisals should be objective and based on predefined criteria, not solely on the nurse manager's preferences. Choice D is incorrect as completed appraisals usually require approval from higher-level management or HR, not necessarily a provider.

2. A nurse is preparing to administer medications to a client via a nasogastric (NG) tube. What should the nurse do first?

• A. Crush all medications and administer them all at once.
• B. Flush the NG tube before and after each medication.
• C. Administer only liquid forms of medications.
• D. Skip flushing the tube entirely.

Correct answer: B

Rationale: The correct answer is B: 'Flush the NG tube before and after each medication.' Flushing the NG tube is essential to ensure that the medication passes through smoothly without any obstruction. It helps prevent clogging of the tube and ensures that the full dose of the medication reaches the patient. Options A, C, and D are incorrect because crushing all medications at once, administering only liquid forms of medications, and skipping tube flushing entirely can lead to complications such as tube blockages, incomplete medication administration, and potential harm to the client.

3. Which patient should the nurse see first?

• A. A 1-month-old infant looking at a shiny, round battery just out of arm's reach.
• B. A 56-year-old patient with oxygen and a lighter on the bedside table.
• C. A 56-year-old patient with oxygen using an electric razor for grooming.
• D. A bedridden patient who has a reddened area on the buttocks and needs to be turned.

Correct answer: B

Rationale: The correct answer is B because the patient with oxygen and a lighter on the bedside table is at immediate risk of fire. Oxygen promotes combustion, and having a lighter nearby poses a serious safety hazard. This situation requires urgent attention to prevent a potential disaster. Choices A, C, and D do not present immediate life-threatening risks compared to the patient with oxygen and a lighter nearby.

4. A patient is receiving a blood transfusion and develops chills, a headache, and low back pain. What is the nurse’s priority action?

• A. Administer acetaminophen
• B. Stop the transfusion
• C. Slow the transfusion rate
• D. Administer antihistamines

Correct answer: B

Rationale: The correct answer is to stop the transfusion (Choice B). The symptoms described - chills, headache, and low back pain - are indicative of a transfusion reaction. The priority action is to immediately stop the transfusion to prevent further complications such as more severe reactions like hemolytic reactions or anaphylaxis. Administering acetaminophen (Choice A) may help with symptoms but does not address the underlying cause. Slowing the transfusion rate (Choice C) may not be sufficient if a serious transfusion reaction is occurring. Administering antihistamines (Choice D) is not the priority in this situation; stopping the transfusion takes precedence to ensure patient safety.

5. A nurse is teaching an older adult client who reports constipation. Which of the following instructions should the nurse include in the teaching?

• A. Increase dietary intake of raw vegetables
• B. Limit activity
• C. Drink four to five glasses of water daily
• D. Bear down hard when defecating

Correct answer: C

Rationale: The correct instruction the nurse should include is to advise the client to drink four to five glasses of water daily. Increasing water intake helps alleviate constipation by softening stool and increasing bowel movements. Choice A, increasing dietary intake of raw vegetables, can be helpful in preventing constipation but may not be sufficient as the sole intervention for someone already experiencing constipation. Choice B, limiting activity, can worsen constipation as physical activity helps stimulate bowel movements. Choice D, bearing down hard when defecating, can lead to other issues like hemorrhoids and should be avoided.

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