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The nurse is assisting the risk manager in reviewing a serious medication error. Which process should the nurse recommend be used to identify the origin of the issue and potential solution?
- A. Root cause analysis
- B. Collective bargaining
- C. Six Sigma
- D. Team STEPPS program
Correct Answer: A
Rationale: Root cause analysis (A) is the standard process to identify the origin of a medication error and develop solutions by analyzing contributing factors. Collective bargaining (B) is labor-related, Six Sigma (C) is a quality methodology, and Team STEPPS (D) focuses on teamwork, none specific to error investigation.
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The nurse is caring for a client who is asking about advanced directives. Many documents fall under the category of an advanced directive. The nurse knows that one of the most common legal papers is called 'Durable Power of Attorney for Health Care' and works to:
- A. Review a person's personal preferences for medical care in the future.
- B. Authorize another person to make medical decisions for a person if they become unable to on their own.
- C. Assign a legal authority in making medical decisions while honoring the spoken word of the family.
- D. Define what care should be administered or withheld by health care professionals, no matter which medical facility the patient finds themselves in.
Correct Answer: B
Rationale: A Durable Power of Attorney for Health Care (B) authorizes a designated person to make medical decisions if the client is incapacitated. Reviewing preferences (A) describes a living will. Honoring family wishes (C) is not legally binding, and defining care across facilities (D) overstates its scope.
The nurse has received the following information about assigned clients. The nurse should first assess the client with
- A. chronic obstructive pulmonary disease (COPD) and has respiratory acidosis on the most recent arterial blood gas (ABG).
- B. atrial fibrillation taking prescribed warfarin and reports black, tarry stools.
- C. diabetes mellitus who refuses to eat following the administration of glargine insulin.
- D. acute pancreatitis and reports nausea with epigastric pain rated as a 3 on the Numerical Rating Scale.
Correct Answer: B
Rationale: Black, tarry stools in a client on warfarin (B) suggest gastrointestinal bleeding, a life-threatening complication requiring immediate assessment. Respiratory acidosis (A) is concerning but less acute if stable. Refusing to eat post-insulin (C) risks hypoglycemia but is less urgent. Pancreatitis pain (D) rated 3/10 is manageable.
The nurse triages phone calls for the primary healthcare provider (PHCP). Which client report requires immediate follow-up? A client reporting
- A. bilateral flank pain who has two nephrostomy tubes.
- B. abdominal cramping while instilling dialysate for peritoneal dialysis (PD).
- C. facial edema while being treated for nephrotic syndrome.
- D. a localized rash following the administration of ciprofloxacin for cystitis.
Correct Answer: C
Rationale: Facial edema in nephrotic syndrome (C) suggests worsening hypoalbuminemia or fluid overload, a medical emergency requiring immediate follow-up. Flank pain (A), dialysis cramping (B), and rash (D) are less urgent, as they are expected or manageable.
The nurse is caring for assigned clients. The nurse should initially follow up on the client who is
- A. three days postoperative following transsphenoidal hypophysectomy and has a temperature of 101°F (38.3°C).
- B. connected to a chest tube for a pneumothorax and has absent breath sounds on the affected side.
- C. receiving albuterol via a nebulizer and telling the unlicensed assistive personnel they feel nervous.
- D. receiving peritoneal dialysis and reports cramping as the solution is being instilled.
Correct Answer: B
Rationale: Absent breath sounds with a chest tube for pneumothorax (B) indicate a life-threatening complication, such as tube dislodgement or re-collapse, requiring immediate assessment. A fever post-hypophysectomy (A) suggests infection but is less urgent. Nervousness from albuterol (C) is a common side effect, and cramping during dialysis (D) is less critical unless severe.
The nurse is demonstrating effective prioritization for assigned clients. Place the actions in the order in which they need to be performed, starting with the highest priority.
- A. Complete an incident report about a client fall that occurred three hours ago.
- B. Perform a sterile dressing change on a client with a sacral wound.
- C. Suction a client's endotracheal tube who is receiving mechanical ventilation.
- D. Administer prescribed antihypertensive medications to a client with hypertension.
- E. Administer a prescribed long-acting bronchodilator via nebulizer for a client with pneumonia.
Correct Answer: C, D, B, E, A
Rationale: 1. Suctioning an endotracheal tube (C) ensures airway patency, a life-saving priority. 2. Administering antihypertensives (D) prevents cardiovascular complications. 3. Sterile dressing change (B) prevents infection but is less urgent. 4. Bronchodilator (E) improves breathing but is long-acting, less time-sensitive. 5. Incident report (A) is administrative and not urgent.