Nokea
The best way to objectively evaluate the effectiveness of an individual staff member's time management skills in a longitudinal manner is to:
- A. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities.
- B. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks.
- C. Ask the staff member how they feel like they have been able to employ their time management skills for the last six months.
- D. Collect outcome data over time and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty.
Correct Answer: D
Rationale: To objectively evaluate time management skills over time, collecting, aggregating, and analyzing outcome data provides a longitudinal perspective on whether the staff member consistently completes assignments within the allotted time. This method is more objective than single-shift observations (A, B) or self-reports .
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A client diagnosed with glomerulonephritis and at risk of developing acute kidney injury should be monitored for which complication?
- A. Bradycardia
- B. Hypertension
- C. Decreased cardiac output
- D. Decreased central venous pressure
Correct Answer: B
Rationale: Acute kidney injury caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of acute kidney injury is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. Acute kidney injury from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for renal failure.
In preparing a plan of care, which is the priority intervention to address the needs of a client recently assaulted sexually?
- A. Providing instructions for medical follow-up
- B. Obtaining appropriate counseling for the victim
- C. Providing anticipatory guidance for police investigations, medical questions, and court proceedings
- D. Exploring safety concerns by obtaining permission to notify significant others who can provide shelter
Correct Answer: D
Rationale: After the provision of medical treatment, the nurse's next priority would be obtaining support and planning for safety. Option 1 is concerned with ensuring that the victim understands the importance of and commits to the need for medical follow-up. From the options provided, this is not a priority intervention. Options 2 and 3 seek to meet the emotional needs related to the rape and emotional readiness for the process of discovery and legal action.
An older client has been prescribed casanthranol on a long-term basis to treat constipation. The nurse determines that which laboratory finding is a result of the side/adverse effects of this medication?
- A. Sodium 135 mEq/L (135 mmol/L)
- B. Sodium 145 mEq/L (145 mmol/L)
- C. Potassium 3.1 mEq/L (3.1 mmol/L)
- D. Potassium 5.0 mEq/L (5.0 mmol/L)
Correct Answer: C
Rationale: Hypokalemia can result from long-term use of casanthranol, which is a laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. The normal range for potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The normal range for sodium is 135 to 145 mEq/L (135 to 145 mmol/L). The remaining options all suggest normal values.
A pregnant woman at 22 weeks' gestation is diagnosed with gonorrhea. The physician orders doxycycline (Vibramycin). The nurse should first:
- A. Inform the client about the effects of the drug.
- B. Make sure the record notes that the baby must receive eyedrops when born.
- C. Have the physician add a single dose of ceftriaxone (Rocephin).
- D. Discuss with the physician the need to change the order.
Correct Answer: D
Rationale: Doxycycline is contraindicated in pregnancy due to risks to the fetus. The nurse should discuss changing the order to a safer alternative, such as ceftriaxone, which is recommended for gonorrhea in pregnancy.
To maintain a safe milieu while addressing the needs of the cognitively impaired clients on the unit, which interventions should the psychiatric nurse implement? Select all that apply.
- A. Use distracting techniques when appropriate.
- B. Be consistently visible and available to the clients.
- C. Provide reality orientation to the clients as needed.
- D. Anticipate the needs of the clients as much as possible.
- E. Segregate potentially volatile clients from the other clients.
Correct Answer: A,B,C,D
Rationale: To maintain a safe milieu for cognitively impaired clients, the nurse should use distracting techniques to redirect inappropriate behaviors, be consistently visible and available to provide reassurance and support, provide reality orientation to help clients maintain awareness of their surroundings, and anticipate client needs to prevent distress or agitation. Segregating potentially volatile clients is not typically recommended as it may increase feelings of isolation or stigmatization; instead, managing their behavior through de-escalation and individualized care is preferred.