Nursing Elites

1. Which situation is an example of the use of evidence-based practice in the delivery of client care?

• A. Encouraging a client who has had a stroke to consume thickened liquids and soft foods
• B. Picking up a dislodged radiation implant with long-handled forceps and placing it in a lead container to minimize radiation exposure
• C. Pouring 1 to 2 mL of sterile solution that will be used for wound cleansing into a plastic-lined waste receptacle before pouring the solution into a sterile basin
• D. Blowing on a fingerstick site to dry it after cleaning the site with an alcohol swab

Correct answer: C

Rationale: Evidence-based practice is an approach that integrates client preferences, clinical expertise, and the best research evidence to deliver quality care. Pouring sterile solution into a plastic-lined waste receptacle before using it for wound cleansing reflects evidence-based practice by preventing the entrance of harmful bacteria into the wound. Option A is incorrect because encouraging a stroke client to consume thickened liquids and soft foods is appropriate, not thin liquids and foods that pose a choking risk. Option B is incorrect as picking up a radiation implant with long-handled forceps to minimize radiation exposure is a safety measure, not evidence-based practice. Option D is incorrect because blowing on a fingerstick site after cleaning can recontaminate the site, which goes against best practices in infection control.

2. When ambulating a client with right-sided weakness, a nursing assistant should be positioned on which side of the client?

• A. Stands behind the client
• B. Positions the free hand on the client's shoulder
• C. Stands on the right side of the client
• D. Grasps the security belt in the midspine area of the small of the client's back

Correct answer: C

Rationale: When ambulating a client with right-sided weakness, the nursing assistant should stand on the affected side, which in this case is the client's right side. This position allows the assistant to provide proper support and assistance. Standing behind the client (Choice A) is incorrect as the assistant should be on the affected side. Positioning the free hand on the client's shoulder (Choice B) is a correct action as it helps in pulling the client toward them in case of a forward fall. Grasping the security belt in the midspine area of the small of the client's back (Choice D) is also correct to provide support and stability during ambulation.

3. While assisting a healthcare provider in assessing a hospitalized client, the healthcare provider is paged to report to the recovery room. The healthcare provider instructs the nurse verbally to change the solution and rate of the intravenous (IV) fluid being administered. What is the most appropriate nursing action in this situation?

• A. Calling the nursing supervisor to obtain permission to accept the verbal prescription
• B. Asking the healthcare provider to write the prescription in the client's record before leaving the nursing unit
• C. Telling the healthcare provider that the prescription will not be implemented until it is documented in the client's record
• D. Changing the solution and rate of the IV fluid per the healthcare provider's verbal prescription

Correct answer: B

Rationale: Verbal prescriptions should be avoided due to the risk of errors. If a verbal prescription is necessary, it should be promptly written and signed by the healthcare provider, typically within 24 hours. Following agency policies and procedures regarding verbal prescriptions is crucial. In this scenario, the most appropriate nursing action is to request the healthcare provider to document the prescription in the client's record before leaving the unit. Calling the nursing supervisor to accept the verbal prescription without documentation, telling the healthcare provider to delay treatment until documented, and directly changing the IV fluid based on verbal orders all pose risks and do not align with best practices in medication administration.

4. During the change of shift, the oncoming nurse notes a discrepancy in the number of Percocet (Oxycodone) listed and the number present in the narcotic drawer. The nurse's first action should be to:

• A. Notify the hospital pharmacist
• B. Notify the nursing supervisor
• C. Notify the Board of Nursing
• D. Notify the director of nursing

Correct answer: B

Rationale: The first action the nurse should take is to report the finding to the nursing supervisor and follow the chain of command. Notifying the nursing supervisor allows for immediate action within the facility to address the discrepancy. If it is found that the pharmacy is in error, then notifying the hospital pharmacist (Choice A) would be appropriate. Choices C and D, notifying the Board of Nursing and the director of nursing, are not the initial steps to take. These options may be necessary if theft is suspected or if the facility's internal response is inadequate. Therefore, they are incorrect answers.

5. A client is having a seizure; his blood oxygen saturation drops from 92% to 82%. What should the nurse do first?

• A. Open the airway.
• B. Administer oxygen.
• C. Suction the client.
• D. Check for breathing.

Correct answer: A

Rationale: When a client is having a seizure and their blood oxygen saturation drops significantly, the priority action for the nurse is to open the airway. This allows for adequate oxygenation and ventilation. Administering oxygen can come after ensuring the airway is clear. Suctioning the client should be done if there is an airway obstruction, and checking for breathing is part of the assessment but opening the airway takes precedence to ensure proper oxygenation and ventilation during a critical event like a seizure.

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