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The nurse is preparing the client's morning prescribed NPH insulin dose and notices a clumpy precipitate inside the insulin vial. Which action should the nurse implement?
- A. Draw the dose from a new vial.
- B. Draw up and administer the dose.
- C. Shake the vial in an attempt to disperse the clumps.
- D. Warm the bottle under running water to dissolve the clump.
Correct Answer: A
Rationale: The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.
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The nurse prepares a client with the diagnosis of right pleural effusion for a thoracentesis; however, the client experiences severe dizziness when sitting upright. Which alternate position should the nurse assist the client into to maintain safety during the procedure?
- A. Right side-lying with the head of the bed flat
- B. Prone with the head turned toward the affected side
- C. Sims' position with the head of the bed elevated 45 degrees
- D. Left side-lying with the head of the bed elevated 45 degrees
Correct Answer: D
Rationale: A thoracentesis is a procedure in which fluid or air is removed from the pleural space via a transthoracic aspiration. Positioning can help isolate the fluid in a pleural effusion; generally, the client sits at the edge of the bed, leaning over the bedside table, allowing the fluid to collect in a dependent body area. If the client is unable to sit up, the nurse turns the client to the unaffected side and elevates the head of the bed 30 to 45 degrees. Turning to the affected side, the prone, and the Sims' positions are unsuitable positions for this procedure because these do not facilitate fluid removal.
When planning the discharge of a client with a diagnosis of chronic anxiety, the nurse develops goals to promote a safe environment at home. Which topic is an appropriate maintenance goal for the client to focus on?
- A. Identifying anxiety-producing situations
- B. Maintaining contact with a crisis counselor
- C. Techniques for ignoring feelings of anxiety
- D. Eliminating all anxiety from daily situations
Correct Answer: A
Rationale: Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations. Additionally, this option does not encourage the development of internal strengths. Ignoring feelings will not resolve anxiety. It is impossible to eliminate all anxiety from life.
Which client should the nurse safely assign to the unlicensed assistive personnel (UAP)?
- A. A client requiring dressing changes
- B. A client requiring frequent ambulation
- C. A client on a bowel management program requiring rectal suppositories
- D. A client newly admitted with nausea, vomiting, and moderate neck pain
Correct Answer: B
Rationale: Assignment of tasks to UAP needs to be made based on job description, level of clinical competence, and state law. The client described in option 2 has needs, frequent ambulation, that can be met by UAP. Options 1, 3, and 4 involve care that requires the skill of a licensed nurse.
A client has a prescription for valproic acid 250 mg once daily. To maximize the client's safety, which time is best for the nurse to schedule administration of the medication?
- A. With lunch
- B. With breakfast
- C. Before breakfast
- D. At bedtime with a snack
Correct Answer: D
Rationale: Valproic acid is an anticonvulsant that causes central nervous system (CNS) depression. For this reason, the side and adverse effects include sedation, dizziness, ataxia, and confusion. When the client is taking this medication as a single daily dose, administering it at bedtime negates the risk of injury from sedation and enhances client safety. Otherwise, it may be given after meals to avoid gastrointestinal upset.
Which scenarios demonstrate a participative style of leadership? Select all that apply.
- A. The nurse manager presents a problem to the staff and tells the staff to solve the problem.
- B. The nurse manager arranges unit meetings for all shifts to deal with an identified problem.
- C. The nurse manager assesses a problem and informs the staff of the solution to be implemented.
- D. The nurse manager proposes several methods of dealing with a problem and invites team input.
- E. The nurse manager proposes several solutions to a problem and has the unit staff vote on the best option.
- F. The nurse manager considers staff input related to a problem but makes the final decision on implementation of the solution.
Correct Answer: B,D,F
Rationale: Participative leadership demonstrates an 'in-between' style, neither authoritarian nor democratic. In participative leadership, the manager presents an analysis of problems and proposals for actions to team members, inviting critique and comments. The participative leader then analyzes the comments and makes the final decision. The autocratic style of leadership is task oriented and directive. A laissez-faire leader abdicates leadership and responsibilities, allowing staff to work without assistance, direction, or supervision. The democratic style of leadership involves a majority rule.