Nursing Elites

1. A nurse is preparing to administer enoxaparin subcutaneously. Which of the following actions should the nurse take?

• A. Administer the medication with the needle at a 45-degree angle.
• B. Administer the medication with the needle at a 90-degree angle.
• C. Administer the medication with the needle at a 30-degree angle.
• D. Administer the medication with the needle at a 15-degree angle.

Correct answer: B

Rationale: Enoxaparin should be administered with the needle at a 90-degree angle to ensure proper subcutaneous delivery. Choice B is correct as it aligns with the recommended angle for subcutaneous injections. Administering enoxaparin at a 45-degree angle (Choice A), 30-degree angle (Choice C), or 15-degree angle (Choice D) would not be appropriate and may lead to improper administration or absorption of the medication.

2. 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: C

Rationale: Fluid-volume deficit causes tachycardia. With correction of the imbalance, the heart rate should return to the expected range. An increase in hematocrit (Choice A) would indicate hemoconcentration, not a successful fluid replacement. An increase in respiratory rate (Choice B) could indicate respiratory distress or hypoxia, not improvement in fluid volume status. A decrease in capillary refill time (Choice D) may indicate improved peripheral perfusion but is not a direct indicator of fluid replacement success.

3. The nurse manager hears a healthcare provider loudly criticize one of the staff nurses within the hearing of others. The employee does not respond to the healthcare provider's complaints. The nurse manager's next action should be to

• A. Approach the healthcare provider and staff nurse for a private meeting to address the situation.
• B. Allow the staff nurse to handle this situation without interference.
• C. Notify other administrative personnel of a breach of professional conduct.
• D. Request an immediate private meeting with the healthcare provider and staff nurse.

Correct answer: D

Rationale: The correct action for the nurse manager in this situation is to request an immediate private meeting with the healthcare provider and staff nurse. By doing so, the nurse manager can facilitate a more appropriate and professional discussion of the issues at hand in a private setting. Option A, which involves addressing the behavior quietly, may not effectively resolve the issue as it needs to be openly discussed. Option B is not advisable as the nurse manager should intervene to address the situation and provide support. Option C, notifying other administrative personnel, may escalate the situation unnecessarily before attempting to resolve it directly with the involved parties.

4. A nurse is caring for an older, immobile patient whose condition requires a supine position. Which metabolic alteration will the nurse monitor for in this patient?

• A. Increased appetite
• B. Increased diarrhea
• C. Increased metabolic rate
• D. Increased pulse rate

Correct answer: D

Rationale: When an older, immobile patient is in a supine position, it increases cardiac workload, leading to an increased pulse rate. This is because the heart rate in older adults may not tolerate the additional workload. Choices A, B, and C are incorrect because an increased appetite, increased diarrhea, and increased metabolic rate are not directly associated with being immobile in a supine position. Increased appetite is more related to nutritional needs or certain medical conditions, increased diarrhea could be due to various causes, and an increased metabolic rate is not typically a direct consequence of lying supine.

5. While providing care to a group of patients, which patient should the nurse prioritize seeing first?

• A. A patient with a hip replacement on prolonged bed rest reporting chest pain and dyspnea
• B. A bedridden patient with a reddened area on the buttocks who needs to be turned
• C. A patient on bed rest with renal calculi who needs to go to the bathroom
• D. A patient post-knee surgery who needs range of motion exercises

Correct answer: A

Rationale: The nurse should prioritize seeing the patient with a hip replacement on prolonged bed rest reporting chest pain and dyspnea first. This patient is at higher risk for deep vein thrombosis due to prolonged bed rest, which can lead to a life-threatening embolus. Chest pain and dyspnea could also indicate a potential pulmonary embolism, which requires immediate assessment and intervention. The other patients, while requiring care, do not present with symptoms that suggest an immediate life-threatening situation, making them lower priority at this time. Therefore, option A is the correct choice as it addresses a potentially critical condition that requires immediate attention.

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