Nursing Elites

1. A nurse manager is preparing to review practice guidelines with a group of newly licensed nurses. Which of the following interventions should the nurse include that is within the RN scope of practice?

• A. Insert an implanted port
• B. Close a laceration with sutures
• C. Place an endotracheal tube
• D. Initiate an enteral feeding through a gastrostomy tube

Correct answer: D

Rationale: The correct answer is D: Initiate an enteral feeding through a gastrostomy tube. It is within the RN scope of practice for nurses to initiate enteral feedings through nasoenteric, gastrostomy, and jejunostomy tubes. Options A, B, and C involve procedures that typically fall within the scope of other healthcare professionals. Inserting an implanted port is often performed by specialized nurses or physicians, closing a laceration with sutures is usually done by healthcare providers with specific training in wound care, and placing an endotracheal tube is a procedure commonly carried out by anesthesiologists or respiratory therapists.

2. The mother of a toddler calls the nurse for help as the baby is choking on his food. The nurse determines that the Heimlich maneuver is necessary based on which finding?

• A. Inability of the toddler to cry or speak
• B. Coughing forcefully
• C. Gagging but able to breathe
• D. Wheezing during respiration

Correct answer: A

Rationale: The correct answer is option A: Inability of the toddler to cry or speak. In cases of choking, the inability to cry or speak indicates a severe airway obstruction where the Heimlich maneuver is necessary to clear the obstruction and establish a patent airway. Option B, coughing forcefully, represents a partial obstruction where the child can still move air, making the Heimlich maneuver not immediately necessary. Option C, gagging but able to breathe, suggests a partial obstruction where air is moving, and the child can still breathe, not requiring immediate intervention like the Heimlich maneuver. Option D, wheezing during respiration, is more indicative of a lower airway issue such as asthma rather than an upper airway obstruction that necessitates the Heimlich maneuver.

3. When teaching adult cardiopulmonary resuscitation (CPR) to a group of newly licensed nurses, what should the charge nurse instruct as the initial response in CPR?

• A. Confirm unresponsiveness
• B. Check for a pulse
• C. Begin chest compressions
• D. Call for emergency help

Correct answer: A

Rationale: The correct initial response in CPR is to confirm unresponsiveness. This step is crucial to ensure that the person actually needs CPR before proceeding with further actions. Checking for unresponsiveness is essential to determine if the individual is in need of immediate assistance. Checking for a pulse or beginning chest compressions without confirming unresponsiveness could waste valuable time and potentially harm the individual. Calling for emergency help is important, but it should follow the confirmation of unresponsiveness to ensure timely activation of emergency services.

4. The nurse plans to assist a male client out of bed for the first time since his surgery yesterday. His wife objects and tells the nurse to get out of the room because her husband is too ill to get out of bed.

• A. Administer nasal oxygen at a rate of 5 L/min
• B. Help the client to lie back down in the bed
• C. Quickly pivot the client to the chair and elevate the legs
• D. Check the client’s blood pressure and pulse deficit

Correct answer: D

Rationale: Checking the client’s blood pressure and pulse deficit is essential before mobilizing a client out of bed, especially after surgery. This assessment helps ensure the client's stability and readiness for mobilization. Administering oxygen or pivoting the client without prior assessment could pose risks if the client is not medically stable. Helping the client lie back down without proper evaluation may delay necessary interventions if the client is indeed ready for mobilization.

5. A healthcare professional is providing care to a client who has a tracheostomy. Which of the following actions should the professional take to prevent complications?

• A. Clean around the stoma with povidone-iodine.
• B. Maintain sterile technique when performing tracheostomy care.
• C. Use clean technique when suctioning the tracheostomy.
• D. Change tracheostomy ties weekly.

Correct answer: B

Rationale: Maintaining sterile technique when performing tracheostomy care is essential in preventing infections and complications. Option A is incorrect because povidone-iodine may be too harsh for cleaning around the stoma and can lead to skin irritation. Option C is incorrect because suctioning a tracheostomy should be done using sterile technique to minimize the risk of introducing pathogens. Option D is incorrect as tracheostomy ties need to be changed more frequently, usually every 1-2 days, to prevent skin breakdown and infection.

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