Nursing Elites

1. For which client situation would a consultation with a rapid response team (RRT) be most appropriate?

• A. 45-year-old; 2 years post kidney transplant; second hospital day for treatment of pneumonia; no urine output for 6 hours; temperature 101.4°F; heart rate of 98 beats per minute; respirations 20 breaths per minute; blood pressure 88/72 mm Hg; is restless
• B. 72-year-old; 24 hours after removal of a chest tube that was used to drain pleural fluid (effusion); temperature 97.8°F; heart rate 92 beats per minute; respirations 28 breaths per minute; blood pressure 132/86 mm Hg; anxious about going home
• C. 56-year-old fourth hospital day after a coronary artery bypass procedure; sore chest; pain with walking temperature 97°F; heart rate 84 beats per minute; respirations 22 breaths per minute; blood pressure 87/72 mm Hg; bored with hospitalization.
• D. 86-year-old; 48 hours postoperative repair of a fractured hip (nail inserted; alert; oriented; using patient-controlled analgesia (PCA) pump; temperature 96.8°F; heart rate 60 beats per minute; respirations 16 breaths per minute; blood pressure 90/62 mm Hg; talking with daughter.

Correct answer: A

Rationale: A consultation with a Rapid Response Team (RRT) is most appropriate for the 45-year-old client described in Choice A. This client is 2 years post kidney transplant, presenting with no urine output for 6 hours, a temperature of 101.4°F, heart rate of 98 beats per minute, respirations of 20 breaths per minute, and a blood pressure of 88/72 mm Hg, along with restlessness. These clinical signs are indicative of possible acute renal failure and sepsis, requiring immediate intervention by the rapid response team. Choices B, C, and D do not present the same level of urgency and severity of symptoms as the client in Choice A, making them less appropriate for consultation with the RRT.

2. During synchronized cardioversion on a client in atrial fibrillation, when the machine is activated, and there is a pause, what action should the nurse take?

• A. Wait until the machine discharges
• B. Shout “all clear” and don’t touch the bed
• C. Make sure the client is all right
• D. Increase the joules and re-discharge

Correct answer: B

Rationale: The correct action for the nurse to take when there is a pause after the machine is activated during synchronized cardioversion is to shout “all clear” and ensure that no one is touching the client or the bed to prevent them from being shocked. This step is crucial for the safety of everyone present during the procedure. Choices A, C, and D are incorrect because waiting without confirming safety, focusing on the client's condition only, or increasing joules without safety precautions can lead to potential harm or injury.

3. Management experience prepares the practical nurse to be a Clinical NCO or a Senior Clinical NCO. These positions are normally held by which of the following?

• A. Army Nurse Corps officer
• B. First Sergeant
• C. E6, E7, or E8
• D. E3, E4, or E5

Correct answer: C

Rationale: Corrected Rationale: Clinical NCO or Senior Clinical NCO positions are typically held by personnel ranked E6, E7, or E8 in the military structure. These individuals have the necessary experience and leadership skills to fulfill the responsibilities associated with these roles. Choices A, B, and D are incorrect because these positions are not specifically designated for Army Nurse Corps officers, First Sergeants, E3, E4, or E5 personnel in the military hierarchy.

4. During a synchronized cardioversion on a client in atrial fibrillation, when the machine is activated and there is a pause, what action should the nurse take?

• A. Wait until the machine discharges
• B. Shout “all clear” and don’t touch the bed
• C. Make sure the client is all right
• D. Increase the joules and re-discharge

Correct answer: B

Rationale: The correct action for the nurse to take when there is a pause after activating the machine for synchronized cardioversion on a client in atrial fibrillation is to shout “all clear” and not touch the bed. This step is crucial to ensure the safety of everyone present by warning them that the machine will discharge, preventing anyone from being inadvertently shocked. Waiting for the machine to discharge (choice A) is not recommended as it can lead to accidental injury. While ensuring the client is all right (choice C) is important, the immediate focus should be on safety during the procedure. Increasing the joules and re-discharging (choice D) without assessing the situation can pose risks to the client and the healthcare team.

5. The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first?

• A. Call a code immediately
• B. Assess the client for a pulse
• C. Begin chest compressions
• D. Continue to monitor the client

Correct answer: B

Rationale: The correct answer is to assess the client for a pulse. In ventricular tachycardia, the priority is to determine if the client has a pulse. If there is no pulse, immediate initiation of CPR with chest compressions is required. Calling a code or continuing to monitor the client can delay life-saving interventions. Therefore, assessing for a pulse is the most crucial step in managing ventricular tachycardia.

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