Nursing Elites

1. What is the main purpose of a clinical audit?

• A. To measure patient satisfaction
• B. To evaluate the effectiveness of clinical practices
• C. To identify areas for improvement
• D. To standardize patient care protocols

Correct answer: C

Rationale: The main purpose of a clinical audit is to identify areas for improvement in clinical practices. While patient satisfaction might be a component evaluated during an audit, the primary goal is to ensure that care is safe, effective, and patient-centered, rather than solely focusing on satisfaction. Evaluating the effectiveness of clinical practices is a related but more specific goal compared to the broader aim of identifying areas for improvement. Standardizing patient care protocols can be a result of a clinical audit, but it is not the main purpose, which is to pinpoint areas needing enhancement.

2. Which of the following is used as an indirect estimate of voluntary absenteeism?

• A. Involuntary absenteeism
• B. Voluntary absenteeism
• C. Total time lost
• D. Absence frequency

Correct answer: D

Rationale: The correct answer is 'Absence frequency.' Absence frequency is the total number of distinct absence periods, regardless of duration. It is used as an indirect estimate of voluntary absenteeism because it provides insights into the frequency of absences. Voluntary absenteeism refers to absences that are under the employee's control, while involuntary absenteeism is not under their control. Total time lost, on the other hand, represents the number of scheduled days that employees miss, which is different from absence frequency.

3. A healthcare professional is caring for a client who has a sodium level of 125 mEq/L (136 to 145 mEq/L). Which of the following findings should the healthcare professional expect?

• A. Positive Chvostek's sign
• B. Bradycardia
• C. Numbness of the extremities
• D. Abdominal cramping

Correct answer: D

Rationale: A sodium level of 125 mEq/L indicates hyponatremia, which can lead to abdominal cramping. Abdominal cramping is a common symptom of hyponatremia due to an imbalance in electrolytes. While other options like Chvostek's sign, bradycardia, and numbness of the extremities can be associated with other electrolyte imbalances, they are not typically seen with low sodium levels. Chvostek's sign is related to hypocalcemia, bradycardia can be seen in hyperkalemia, and numbness of the extremities can be a symptom of hypocalcemia or hypokalemia, but not directly related to hyponatremia.

4. After correcting the IVF infusion rate, what should be the next step in the client's care?

• A. Notify family
• B. Discipline the previous nurse
• C. Complete an incident report
• D. Obtain legal consultation

Correct answer: C

Rationale: The correct next step in the client's care after correcting the IVF infusion rate is to complete an incident report. This report is crucial for documenting the event, identifying the root cause of the error, and implementing measures to prevent similar incidents in the future. Notifying the family, disciplining the previous nurse, and obtaining legal consultation are not immediate priorities in this situation. Family notification may be necessary later but ensuring patient safety and proper documentation come first. Disciplining the previous nurse should be handled through the appropriate professional channels, not as an immediate response to the incident. Legal consultation may be needed in some cases but is not the initial step required after correcting the error and ensuring the client's safety.

5. During a physical assessment of adult clients, which of the following techniques should the nurse use?

• A. Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale for a client experiencing pain.
• B. Palpate the client's abdomen before auscultating bowel sounds.
• C. Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
• D. Obtain an apical heart rate by auscultating at the third intercostal space to the left of the sternum.

Correct answer: B

Rationale: When performing a physical assessment, it is essential to palpate the client's abdomen before auscultating bowel sounds. This sequence helps prevent altering bowel sound results due to the pressure applied during palpation. Choice A is incorrect because the FLACC pain rating scale is typically used for nonverbal or pediatric clients, not adults. Choice C is incorrect because the bladder of the blood pressure cuff should surround about 80% of the client's arm circumference, not the bladder of the cuff itself. Choice D is incorrect because to obtain an apical heart rate, auscultation should be done at the fifth intercostal space at the midclavicular line, not at the third intercostal space to the left of the sternum.

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