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NCLEX CRITICAL THINKING EXERCISE FOR MAKING ROOM ASSIGNMENTS: You are caring for a client with AIDS that is in a semi-private room. Of the following, which client would you put in the room with the client with AIDS? 1. A client with asthma. 2. A client that is 8 hours post-appendectomy. 3. A client with bronchitis Answer: 1. Correct: Asthma because thats the only one thats not infectious. 2. Bronchitis can be bacterial or viral, right? 3. And you would never put a fresh incision in a room with somebody thats HIV positive, now, would you? No. Cross contamination could occur.

NCLEX Critical Thinking Exercise:

Youre working in the emergency department and an 18-month old little girl comes into the hospital. She has been diagnosed with rotavirus, she is severely dehydrated. She has not cried or wet a diaper in 5 hours. The doctor has written the following order: Give D5 NS with 20mEq of KCL at 20 mls per hour per pump. Would you carry out this order? Why or why not? NO Well, weve already said that fluids are needed. Right? Okay, when you listen to that critical thinking exercise, what are you worried about? Potassium Why are you worried about potassium? Because they have not wet a diaper in five hours. But does the baby still need the fluid? Yes. So, what you do is you go ahead and start your IV, right? Yes. You get your D5 NS going and you call the primary healthcare provider and say, Look, I am not giving this baby any potassium until they start wetting their diaper, okay? We will not start giving the baby potassium in their fluid until the baby has started to void----wetting diapers. Is that what they want you to do? Yes. Yall, primary healthcare providers want you to look at the prescriptions or orders. The NCLEX lady likes the word prescription so that is why we are using it. We want you to feel comfortable with that word!

They write prescriptions all day long and we have to be able to look at those prescriptions and find those that we question. They want us to question the orders. Now, its not fun, I know, to call a primary healthcare provider and question an order. But, theres never anything wrong with seeking clarification. Youve got the right to do that, okay?

NCLEX Critical Thinking Exercise:

Part I: Lets say that you are the charge nurse on an adult medical surgical unit. You are short an RN staff member, and the nursing supervisor has sent an RN with neonatal intensive care experience to your unit. The nurse states on arrival, I have not worked on an adult unit for 6 years. As the charge nurse, what should you do first?

1. 2. 3. 4.

Send the RN back to NICU and give the nurses working on the floor already an extra client. Call the nursing supervisor and demand a RN with med-surg experience. Attend the shift report. Assign the nurse to do nursing assistant duties.

Answers: 1. Send the RN back to NICU and give the nurses working on the floor already an extra client.. Doing this is a waste of a valuable RN resource and a waste of money. Also, it does not solve the problem. Also, this would be unsafe..for the clients and the nurse to have an extra client. 2. Call the nursing supervisor and demand a RN with med-surg experience. If the supervisor had a RN with med-surg experience, would a NICU nurse have been sent to you? 3. Correct: Attend the shift report. This will allow the charge nurse to assess the situation and to make assignments based on client and unit needs. Assessment always comes first even with delegation and assignments! 4. Assign the nurse to do nursing assistant duties. Doing this is a waste of a valuable RN resource and a waste of money.

Part II: Which of the following clients would you assign the NICU nurse that is working on your floor?

1. 2. 3. 4.

4 hour post cholecystectomy client experiencing pain every 2 hours. Elderly client with unexplained syncope. Teenager client 8 hours post hypophysectomy. New admit diagnosed with adrenal insufficiency.

Answers: 1. Correct: 4 hours post cholecystectomy client experiencing pain every 3 4 hours. Non-complicated client. 2. Elderly client with unexplained syncope? This client is at risk for MI or severe electrolyte imbalance. Needs close monitoring. 3. Teenager client 8 hours post hypophysectomy? This client is at risk for developing diabetes insipidus. Sinus surgery is a little close to my pituitary gland. Needs close monitoring. 4. New admit diagnosed with adrenal insufficiency? This client is deficient in all steroids: glucocorticoids, mineralcorticoids, and sex hormones. At risk for fluid volume deficit, and shock. This client is considered unstable, and is not a candidate for a pulled nurse.

NCLEX Critical Thinking Exercise:

You are caring for a client that has hypothyroidism. Your client is scheduled to be given an AM dose of Levothyroxine (Synthroid). While you are in the clients room, she states that shes been feeling this fullness in her chest that started after she ate and has lasted for the last 2 hours. What should the nurse do first?

1. 2. 3. 4.

Administer Aluminum/Magnesium concentrate and suspension (Maalox) 30 ml. Administer the Levothyroxine (Synthroid). Obtain a 12- lead EKG. Call the primary healthcare provider.

Answers: 1. Administer Maalox 30 mL. Is this going to help the client? No..Maalox will not stop a client from having an MI will it? That is what you are telling the NCLEX lady.the DOC for an MI would be Maalox. We need to start with MONA.right.but that was not an option so we have to go with what they give us. 2. Administer the Synthroid. I dont think so this will make the problem worse! 3. Obtain a stat EKG.this is delaying carewill this fix the problem? NO we have to select an answer that is going to fix the problem.if you selected that for your answer you are looking at the EKG.You know you have no idea what it says! 4. Correct: Call the primary healthcare provider.because you know that Synthroid increases the heart rate and puts an increased workload on heart that has CAD. So could this client be having an MI.Yesand the only option here that will fix the problem the fact the client is having an MI.is to call the primary healthcare provider.

NCLEX Critical Thinking Exercise: A nurse is assisting a primary healthcare provider inserting a central line, for a client diagnosed with sepsis. After inserting the central line. Which of the following options would be most appropriate?

1. 2. 3. 4.

Start the ordered antibiotics. Allow the primary healthcare provider to start the antibiotics as ordered. Check for blood return and if present start the antibiotics ordered. Administer the stat antibiotics after you have confirmation of placement of the central line.

This is the only safe answer. We are not going to start the antibiotics at all.I dont care who starts it because the client may have a pneumothorax!!!

NCLEX Critical Thinking Exercise: An obstetrician already has three clients on the Labor unit receiving Oxytocin (Pitocin) for induction of labor. All of the women are 38 weeks gestation. This labor unit has 6 beds and four nurses are on duty: 3 RN staff members and 1 RN nurse manager. The primary healthcare provider calls from the office to inform the nurse manager that a fourth client is en-route to the labor unit with orders to start an Oxytocin (Pitocin) induction. Which next action by the nurse manager is priority?

1. 2. 3. 4.

Assign yourself to monitor one client receiving Oxytocin (Pitocin) Request for delay of induction until one client delivers. Call nursing supervisor, requesting float nurse from another floor. Report the primary healthcare provider to the PRO review committee for indiscriminate inductions.

Correct answer? #2: Negotiate for a delay of induction until one client delivers. The priority will always be client safety! Option #1 AND #3 ARE unsafe Option #4 is definitely viable! This obstetrician should have to answer to his peers, but the priority is client safety.