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The old client had to walk along the hall to reach the examination room. During assessment the nurse hears an S4. Which is the best intervention at this moment?
- A. Practice an EKG
- B. Administer nitroglycerin sublingual
- C. Allow rest recumbent for 30 minutes
- D. Call MD immediately
Correct Answer: C
Rationale: An S4 in an elder post-walk suggests diastolic stiffness the nurse allows 30 minutes recumbent rest, not EKG, nitroglycerin, or calling. S4 often reflects aging or exertion, not acute ischemia; rest distinguishes transient from persistent findings. EKG or nitroglycerin assumes angina, and calling escalates prematurely. Leadership opts for this imagine a tired patient; rest clarifies if S4 persists, guiding next steps. This reflects nursing's prudent assessment, ensuring accurate cardiac care in geriatrics effectively.
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A client with rheumatoid arthritis is prescribed methotrexate. Which laboratory value should the nurse monitor?
- A. White blood cell count
- B. Serum creatinine
- C. Blood glucose
- D. Serum potassium
Correct Answer: A
Rationale: For methotrexate in RA, monitor WBC, not creatinine, glucose, or potassium. This immunosuppressant risks leukopenia infection looms if low. Kidneys matter, but marrow's primary. Leadership watches this imagine fever; it ensures safety, aligning with RA therapy effectively.
As a new nurse manager who has 'inherited' a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to:
- A. Determine levels of nurse engagement on the unit
- B. Review the personnel files of nurses who have resigned
- C. Interview upper management about their vision for the unit
- D. Meet with your staff to clarify your vision for the unit
Correct Answer: A
Rationale: High turnover and patient dissatisfaction often stem from low nurse engagement disconnection from work or leadership impacting care quality. As a new manager, assessing engagement through observation, surveys, or discussions reveals root causes, like poor morale or autonomy, guiding targeted improvements. Reviewing files offers historical data but not current dynamics. Interviewing management or sharing your vision comes later understanding staff engagement first grounds your strategy in the unit's reality. Studies (e.g., Aiken) show engaged nurses improve outcomes and retention, making this the critical starting point to address both issues effectively.
A client with a history of hypertension is prescribed lisinopril. Which instruction should the nurse include?
- A. Monitor for a persistent dry cough
- B. Increase intake of potassium-rich foods
- C. Take the medication with meals
- D. Stop the medication if you feel dizzy
Correct Answer: A
Rationale: For lisinopril in HTN, monitor for dry cough, not potassium, meals, or stopping. ACE inhibitors cause cough potassium's risky, food's fine, dizziness needs MD. Leadership teaches this imagine hacking; it ensures awareness, aligning with HTN care effectively.
The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that is used to maximize the achievement of the desired objective. Which decision-making model does this manager use?
- A. Political decision-making model
- B. Experimentation process
- C. Rational decision-making model
- D. Trial-and-error method
Correct Answer: C
Rationale: The rational decision-making model uses a stepwise, logical approach to maximize objectives, unlike political, experimentation, or trial-and-error. Nurse managers employing this like scheduling staff to reduce overtime analyze options systematically, contrasting with intuitive methods. This ensures decisions align with goals, such as patient safety or resource efficiency, critical in healthcare's structured environment. Leadership here emphasizes evidence over politics or guesswork, fostering trust and consistency in high-stakes settings where errors impact lives.
An RN and a licensed practical nurse (LPN) are caring for a client who has a small bowel obstruction and is NPO with a nasogastric (NG) tube set to continuous suction. Which of the following tasks should the RN perform?
- A. Administer IV fluids
- B. Assess for bowel sounds every 2 hours
- C. Monitor NG tube output
- D. Reposition the NG tube
Correct Answer: B
Rationale: The RN's scope of practice includes assessments requiring clinical judgment, such as evaluating bowel sounds to determine hypoactive, normal, or hyperactive states, which informs the care plan for a small bowel obstruction. This task demands interpretive skills beyond the LPN's role, which focuses on data collection (e.g., listening for sounds) rather than analysis. Administering IV fluids, monitoring NG tube output, and repositioning the tube are within the LPN's capabilities under RN supervision, as they involve technical execution rather than diagnostic reasoning. The RN's expertise ensures accurate assessment of bowel function, critical for detecting complications like perforation or resolution of the obstruction, guiding subsequent interventions, and maintaining client safety in a condition requiring precise monitoring and decision-making.