Nursing Elites

1. The nurse is taking a health history from a 29-year-old pregnant patient at the first prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic. Which action will the nurse plan to take first?

• A. Teach the patient about administering regular insulin.
• B. Schedule the patient for a fasting blood glucose level.
• C. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy.
• D. Provide teaching about an increased risk for fetal problems with gestational diabetes.

Correct answer: B

Rationale: The correct answer is B. Given the family history of diabetes, the initial action the nurse should take is to schedule the patient for a fasting blood glucose level. This will help in assessing if the patient has developed gestational diabetes. Choice A is incorrect because teaching about administering regular insulin is premature without confirming the diagnosis. Choice C is incorrect as an oral glucose tolerance test is typically done earlier in pregnancy. Choice D is incorrect as discussing fetal problems related to gestational diabetes should come after a confirmed diagnosis.

2. A nurse is caring for a client who is postoperative and is exhibiting signs of hemorrhagic shock. The nurse notifies the surgeon, who tells the nurse to continue to measure the client's vital signs every 15 min and to report back in 1 hour. Which of the following actions should the nurse take next?

• A. Document the surgeon's instructions in the client's medical record.
• B. Complete an incident report.
• C. Consult the charge nurse.
• D. Notify the nursing manager.

Correct answer: D

Rationale: In this scenario, the nurse should notify the nursing manager next. The surgeon's instructions are related to the client's condition, and it is crucial to inform the nursing manager about the situation. Option A is incorrect because documenting the surgeon's instructions in the medical record is not the immediate next step. Option B is also incorrect as completing an incident report is not warranted in this situation. Option C is not the best choice as consulting the charge nurse may cause a delay in escalating the situation to higher management, which is necessary in cases of emergency like hemorrhagic shock.

3. A nurse is admitting a new client. Which of the following actions should the nurse take while performing medication reconciliation?

• A. Compare the client's home medications with the provider's prescriptions
• B. Place the client's home medication bottles in a secure location
• C. Call the pharmacy to determine whether the client's medications are available
• D. Verify the client's name on their identification bracelet with the medication administration record

Correct answer: A

Rationale: The correct answer is A. During medication reconciliation, the nurse should compare the client's home medications with the provider's prescriptions to ensure accurate and safe administration. This process helps identify any discrepancies or potential interactions. Choice B is incorrect because placing the client's home medication bottles in a secure location is not part of medication reconciliation. Choice C is incorrect as calling the pharmacy to determine medication availability is not related to reconciling medications. Choice D is incorrect as verifying the client's name on their identification bracelet with the medication administration record is part of the identification process, not medication reconciliation.

4. A nurse recognizes which of the following as a primary goal of nursing?

• A. Assist patients to achieve a peaceful death.
• B. Improve personal knowledge and skills to enhance patient outcomes.
• C. Advocate for quality of life over the quantity of life.
• D. Work to control costs to enhance patients' quality of life.

Correct answer: A

Rationale: The correct answer is A: 'Assist patients to achieve a peaceful death.' One of the primary goals of nursing is to help patients experience a comfortable and peaceful passing when faced with terminal illness or at the end of life. This involves providing holistic care, managing symptoms, and ensuring that patients are as comfortable and pain-free as possible. Choices B, C, and D are incorrect because while improving knowledge and skills, advocating for quality of life, and controlling costs are important aspects of nursing care, they are not the primary goal related to end-of-life care.

5. A nurse is admitting a client who has an abdominal wound with a large amount of purulent drainage. Which of the following types of transmission precautions should the nurse initiate?

• A. Droplet precautions
• B. Protective environment
• C. Airborne precautions
• D. Contact precautions

Correct answer: D

Rationale: The correct answer is D: Contact precautions. Contact precautions are used when there is a risk of transmission of infections through direct or indirect contact. In this scenario, the client has an abdominal wound with purulent drainage, indicating a potential for infection transmission through contact. Droplet precautions (choice A) are used for infections transmitted through respiratory droplets, such as influenza. Protective environment (choice B) is used for immunocompromised clients. Airborne precautions (choice C) are used for infections transmitted through small droplets that remain in the air, like tuberculosis. Therefore, in this case, the nurse should initiate contact precautions to prevent the spread of infection.

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