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When should the nurse initiate discharge planning for a client experiencing an exacerbation of heart failure?
- A. During the admission process
- B. As soon as the client's condition is stable
- C. After consulting with the client's family
- D. During the initial team conference
Correct Answer: B
Rationale: The correct time for the nurse to initiate discharge planning for a client experiencing an exacerbation of heart failure is as soon as the client's condition is stable. Discharge planning should begin early in the admission process to ensure a smooth transition and continuity of care. While involving the client's family in the planning process is crucial, the primary focus should be on starting the preparations for discharge once the client's immediate health concerns are addressed and their condition is stable. Waiting for a team conference or after consulting with the family may delay the planning process, which is not ideal in ensuring a timely and effective discharge plan.
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A client is receiving pain medication through a PCA pump. Which of the following actions should the nurse take?
- A. Educate the family not to push the button for the client while the client is asleep.
- B. Explain to the client that vital signs will be monitored regularly due to being on a PCA pump.
- C. Instruct the client to push the button only when pain is above a 7 on a scale of 0 to 10.
- D. Adjust the basal rate and decrease the lock-out interval time if the client's pain level is too high.
Correct Answer: D
Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.
Caring is a fundamental value in nursing and serves as the basis for caring leadership. Which of the following statements is true about a caring leader?
- A. A caring leader prioritizes serving others before leading.
- B. A caring leader recognizes and acknowledges the emotions of others.
- C. Traits of a caring leader involve respecting coworkers as individuals and empathizing with their needs and concerns.
- D. A caring leader demonstrates fairness and honesty.
Correct Answer: C
Rationale: A caring leader embodies traits such as respecting coworkers as unique individuals and showing empathy towards their needs and concerns. These qualities are essential for fostering a supportive and compassionate work environment, where team members feel valued and understood. Choice A is incorrect because a caring leader balances serving others with effective leadership, not prioritizing one over the other. Choice B, though important, focuses solely on recognizing emotions and does not encompass the broader traits of caring leadership. Choice D is also important but does not capture the essence of respecting individuals and empathizing with their needs, which are core aspects of caring leadership.
What should the nurse do after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?
- A. Assess the patient for symptoms of hyperglycemia.
- B. Give the patient a snack of peanut butter and crackers.
- C. Have the patient drink a glass of orange juice or nonfat milk.
- D. Administer a continuous infusion of 5% dextrose for 24 hours.
Correct Answer: B
Rationale: After a patient treated with intramuscular glucagon for hypoglycemia regains consciousness, providing a snack of peanut butter and crackers is essential to prevent another episode of hypoglycemia. Peanut butter and crackers contain a combination of protein and carbohydrates, which can help stabilize the patient's blood glucose levels. This choice is the most appropriate immediate action to prevent recurrence of hypoglycemia in this scenario. Assessing for symptoms of hyperglycemia (choice A) is not the immediate priority after treating hypoglycemia. While orange juice or nonfat milk (choice C) can help raise blood sugar, they lack the sustained effect of protein found in peanut butter. Administering continuous infusion of dextrose (choice D) is excessive and not indicated after the patient has already regained consciousness.
An RN’s current patient and family have presented her with an ethical dilemma. What is the first step the RN should take to find a workable solution to the problem?
- A. Planning
- B. Assessment
- C. Evaluation
- D. Implementation
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
As a new nurse at a healthcare organization offering a nurse residency program, what would benefit you the most?
- A. Avoiding challenging patient assignments to minimize the risk of errors.
- B. Relying on your clinical preceptor, similar to your relationship with your nurse faculty.
- C. Establishing professional goals based on your clinical knowledge.
- D. Engaging in evidence-based practice projects immediately.
Correct Answer: C
Rationale: As a new nurse joining a nurse residency program, the most beneficial action would be to establish professional goals based on your clinical knowledge. Setting clear goals allows you to focus on your learning needs, competency development, and guidance from your clinical preceptor. This proactive approach helps you maximize your learning opportunities, shape your professional growth, and enhance your skills as a novice nurse. Choice A is incorrect because avoiding challenging patient assignments may hinder your learning and skill development. Choice B is incorrect as while the clinical preceptor is essential, solely relying on them without personal professional goals may limit your growth. Choice D is incorrect because engaging in evidence-based practice projects immediately may be overwhelming for a new nurse without first establishing foundational goals.