Nokea
The nurse is serving on the performance improvement committee, which has agreed to some changes in procedures on the basis of evidence-based research. If the committee wants to convince staff members to comply with the changes, which of the following actions should the committee carry out first?
- A. Identify and gain support of key staff.
- B. Explain the consequences of failure to comply.
- C. Determine a reward system for compliance.
- D. Clearly outline expectations in written format.
Correct Answer: A
Rationale: Gaining key staff support (A) builds buy-in and facilitates change adoption. Consequences (B), rewards (C), or written expectations (D) follow.
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Which client is at greatest risk for a caesarean section due to cephalopelvic disproportion (CPD)?
- A. A 25-year-old gravida 2, para 1
- B. A 30-year-old gravida 3, para 2
- C. A 17-year-old gravida 1, para 0
- D. A 32-year-old gravida 1, para 0
Correct Answer: C
Rationale: A 17-year-old primigravida is at higher risk for CPD due to a potentially underdeveloped pelvis, increasing the likelihood of cesarean delivery.
The nurse is infusing total parenteral nutrition (TPN) through a peripherally inserted central catheter. The client's TPN was turned off for 1 hour for an MRI. Which action by the nurse is most appropriate for this client?
- A. notify the health care provider for further orders
- B. discard the volume of the TPN that should have been administered and make a note in the chart
- C. double the flow rate on the infusion for 1 hour to keep the TPN on schedule, and then resume the normal flow rate
- D. increase the flow rate on the infusion for two hours to keep the TPN on schedule, and then resume the normal flow rate
Correct Answer: A
Rationale: Notifying the provider ensures proper adjustment of TPN administration, as altering rates or discarding solution can cause metabolic imbalances.
The nurse is preparing to suction the client with a tracheotomy. The nurse notes a previously used bottle of normal saline on the client's bedside table. There is no label to indicate the date or time of initial use. The nurse should:
- A. Lip the bottle and use a pack of sterile 4x4 for the dressing
- B. Obtain a new bottle and label it with the date and time of first use
- C. Ask the ward secretary when the solution was requested
- D. Label the existing bottle with the current date and time
Correct Answer: B
Rationale: Using an unlabeled, previously opened saline bottle risks contamination; a new, labeled bottle ensures sterility.
The client is admitted to the ER with multiple rib fractures on the right. The nurse's assessment reveals that an area over the right clavicle is puffy and that there is a 'crackling' noise with palpation. The nurse should further assess the client for which of the following problems?
- A. Flail chest
- B. Subcutaneous emphysema
- C. Infiltrated subclavian IV
- D. Pneumothorax
Correct Answer: B
Rationale: The 'puffy' area and 'crackling' noise (crepitus) with palpation are classic signs of subcutaneous emphysema, where air is trapped under the skin, often due to a pneumothorax or rib fractures allowing air to escape into subcutaneous tissue.
The nurse caring for a client diagnosed with metastatic cancer of the bone is exhibiting mental confusion and a BP of 150/100. Which laboratory value would correlate with the client's symptoms reflecting a common complication with this diagnosis?
- A. Potassium 5.2 mEq/L
- B. Calcium 13 mg/dL
- C. Inorganic phosphorus 1.7 mEq/L
- D. Sodium 138 mEq/L
Correct Answer: B
Rationale: Bone metastasis often causes hypercalcemia (calcium 13 mg/dL is elevated), leading to confusion and hypertension. The other values are normal or unrelated.