Nursing Elites

1. Which of the following is MOST LIKELY to increase the risk of a medication error?

• A. Not using abbreviations for medications
• B. Errors in the calculation of medication dosages
• C. Barcoding medication orders
• D. Utilizing unit dose dispensers

Correct answer: B

Rationale: Errors in the calculation of medication dosages are a significant risk factor for medication errors. When dosage calculations are incorrect, it can lead to administering the wrong amount of medication, posing serious harm to the patient. Avoiding abbreviations for medications, barcoding medication orders, and utilizing unit dose dispensers are all strategies aimed at reducing medication errors by enhancing accuracy and safety. Therefore, choices A, C, and D are incorrect as they are practices that help decrease, rather than increase, the risk of medication errors.

2. A client who had a hip replacement is being prepared for discharge. What should the nurse include in the discharge teaching to prevent hip dislocation?

• A. Avoid crossing your legs at the knees or ankles.
• B. Do not sleep on the side of the hip that was operated on.
• C. Sit in high chairs and keep your knees higher than your hips.
• D. Do not bend forward at the waist to pick up objects.

Correct answer: A

Rationale: The correct answer is A: 'Avoid crossing your legs at the knees or ankles.' Crossing legs at the knees or ankles can cause excessive stress on the new hip joint, leading to a risk of dislocation. Choice B is incorrect because sleeping on the side of the operated hip can also increase the risk of dislocation. Choice C is incorrect as sitting in low chairs with knees higher than hips is a recommended position to prevent hip dislocation. Choice D is incorrect because bending forward at the waist to pick up objects can strain the hip joint and increase the risk of dislocation.

3. The practical nurse is caring for a client who had a total laryngectomy, left radical neck dissection, and tracheostomy. The client is receiving nasogastric tube feedings via an enteral pump. Today the rate of feeding is increased from 50 ml/hr to 75 ml/hr. What parameter should the PN use to evaluate the client's tolerance to the rate of the feeding?

• A. Daily weight
• B. Gastric residual volumes
• C. Bowel sounds
• D. Urinary and stool output

Correct answer: B

Rationale: Monitoring gastric residual volumes helps to assess how well the client is tolerating the increased feeding rate. High residuals may indicate delayed gastric emptying, which could lead to complications like aspiration. This helps in adjusting the feeding plan as necessary. Daily weight (Choice A) is not the most appropriate parameter to evaluate tolerance to feeding rate changes. Bowel sounds (Choice C) and urinary/stool output (Choice D) are important assessments but do not directly indicate tolerance to enteral feeding rate changes.

4. A client has a prescription for a transcutaneous electrical nerve stimulator (TENS) unit for pain management during the postoperative period following a lumbar laminectomy. Which information should the nurse reinforce about the action of this adjuvant pain modality?

• A. The discharge of electricity will distract the client's focus from the pain
• B. An infusion of medication in the spinal canal will block pain perception
• C. Pain perception in the cerebral cortex is dulled by the unit's discharge of an electrical stimulus
• D. A mild electrical stimulus on the skin surface closes the gates of nerve conduction for severe pain

Correct answer: D

Rationale: The correct answer is D. TENS works by delivering a mild electrical stimulus to the skin, which can help close the 'gates' in the nervous system to block pain signals from reaching the brain, thus reducing pain perception. Choice A is incorrect because TENS does not distract from pain but rather helps manage it. Choice B is incorrect as it describes a different pain management technique involving medication in the spinal canal. Choice C is incorrect because TENS acts peripherally on nerve conduction rather than dulling pain perception in the cerebral cortex.

5. A client tells the PN that she has a family history of cancer and has increased the amount of dairy products in her diet to reduce her risk of getting cancer. How should the PN respond?

• A. Encourage the client to get plenty of exercise in addition to the dietary change
• B. Provide written information about the seven warning signs of cancer
• C. Remind the client to ensure that the dairy products are fortified with Vitamin D
• D. Suggest that an increase in fruits and vegetables is more beneficial

Correct answer: D

Rationale: Increasing fruits and vegetables in the diet is more beneficial in reducing cancer risk due to their high levels of antioxidants and fiber, which help protect against cancer. While exercise is important for overall health, in this context, focusing on fruits and vegetables is more relevant to reducing cancer risk than exercise alone. Providing information about cancer warning signs is not directly addressing the client's dietary choice. While Vitamin D is essential for various health aspects, the primary focus here should be on a diet rich in fruits and vegetables for cancer risk reduction.

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