Nursing Elites

1. Which is an example of a sentinel event?

• A. The terminally ill client is referred to hospice and dies 3 months later.
• B. A client receives an unordered mammogram which reveals a small cyst.
• C. A client with a laceration to the knee requiring 4 sutures falls when getting up unassisted after being instructed to remain in bed.
• D. A client scheduled for knee replacement surgery had an above-the-knee amputation performed.

Correct answer: D

Rationale: Yes! A sentinel event is an unexpected occurrence causing death or serious injury. In this case, a client who was scheduled for knee replacement surgery but had an above-the-knee amputation performed instead represents a sentinel event as it resulted in serious harm that was not intended. The other choices do not meet the criteria for a sentinel event. Choice A describes a natural progression for a terminally ill client, choice B shows an incidental finding from a test, and choice C involves a preventable fall leading to an injury but not a sentinel event.

2. Which of the following terms refers to soft tissue injury caused by blunt force?

• A. contusion
• B. strain
• C. sprain
• D. dislocation

Correct answer: A

Rationale: A contusion is a soft tissue injury caused by blunt force. It is an injury that does not break the skin, caused by a blow, and characterized by swelling, discoloration, and pain. The immediate application of cold might limit the development of a contusion. A strain is a muscle pull from overuse, overstretching, or excessive stress. A sprain is caused by a wrenching or twisting motion. A dislocation is a condition where the articular surfaces of the bones forming a joint are no longer in anatomical contact. Therefore, the correct answer is 'contusion' as it specifically relates to soft tissue injury caused by blunt force.

3. A healthcare professional is reviewing a patient's ECG report. The patient exhibits a flat T wave, depressed ST segment, and short QT interval. Which of the following medications can cause all of the above effects?

• A. Morphine
• B. Atropine
• C. Procardia
• D. Digitalis

Correct answer: D

Rationale: The correct answer is Digitalis. Digitalis is known to cause a flat T wave, depressed ST segment, and a short QT interval on an ECG report. These ECG changes are characteristic of digitalis toxicity. Morphine is not typically associated with these ECG changes. Atropine is more commonly linked to increasing heart rate rather than causing these specific ECG abnormalities. Procardia is a calcium channel blocker that does not typically produce the described ECG findings. Therefore, Digitalis is the most likely medication causing these effects in the patient.

4. The client in the Emergency Department, who has suffered an ankle sprain, should be taught to:

• A. use cold applications to the sprain during the first 24-48 hours.
• B. expect disability to decrease within the first 24 hours of injury
• C. expect pain to decrease within 3 hours after injury.
• D. begin progressive passive and active range of motion exercises immediately.

Correct answer: A

Rationale: When a client suffers an ankle sprain, the nurse should teach them to use cold applications to the sprain during the first 24-48 hours. Cold applications are believed to produce vasoconstriction and reduce the development of edema. Expecting disability to decrease within the first 24 hours of injury (choice B) is incorrect as disability and pain are anticipated to increase during the first 2-3 hours after injury. Expecting pain to decrease within 3 hours after injury (choice C) is also incorrect as pain and swelling usually increase initially. Beginning progressive passive and active range of motion exercises immediately (choice D) is not recommended; these exercises are usually started 2-5 days after the injury, according to the physician's recommendation. Treatment for a sprain involves support, rest, and alternating cold and heat applications. X-ray pictures are often necessary to rule out any fractures.

5. Melissa Smith came to the Emergency Department in the last week before her estimated date of confinement complaining of headaches, blurred vision, and vomiting. Suspecting PIH, the nurse should best respond to Melissa's complaints with which of the following statements?

• A. "The physician will probably want to admit you for observation."?
• B. "The physician will probably order bedrest at home."?
• C. "These are really dangerous signs."?
• D. "The physician will probably prescribe some medicine for you."?

Correct answer: B

Rationale: Pregnancy-induced hypertension (PIH) is a hypertensive disorder of pregnancy that can present after 20 weeks gestation. It is characterized by symptoms like edema, hypertension, and proteinuria, which can progress to conditions like pre-eclampsia and eclampsia. The best approach for a client with advanced PIH is rest, and home provides the most suitable environment for it. Hospitalization is not typically necessary for PIH unless there are severe complications. Medication alone is not the primary intervention for PIH; management often involves monitoring, rest, and close medical supervision. Therefore, advising bedrest at home is the most appropriate response to help manage PIH symptoms and prevent further complications, such as pre-eclampsia or eclampsia. The other options, like hospitalization for observation, emphasizing the danger of the signs without providing guidance, or assuming medication as the primary solution, are not in line with the standard management approach for PIH.

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