What Do Nurses Do?

My children and I were talking recently about what a nurse does. I asked the kids if they knew what a nurse does. This brought an interesting response from Isaac. He said, "Nurses help the doctors by doing what the doctor says to do."

Wow.

I was blown away that that is what my children thought a nurse does. But, to be honest, before nursing school, my knowledge of what nurses did was fair, at best.

So, I thought it would be interesting to try to list some of the responsibilities of nurses. I will follow each with an NCLEX question relating to that responsibility because I am in NCLEX study mode still.

In no particular order except what comes to my mind:

Nurses must prioritize care and decide which client needs medical attention first.

1) After receiving report, which of the following clients should the nurse see first?
A. A 14-year old client in sickle-cell crisis with an infiltrated IV.
B. A 59-year old client with leukemia who has received half of a packed red blood cell transfusion.
C. A 68-year old client scheduled for a bronchoscopy.
D. A 74-year old client complaining of a leaky colostomy bag?

The nurse must delegate safely and appropriately to LPNs and Nurse's Aids, taking into account their education, skill level and scope of practice - while retaining final responsibility for delegated tasks.

2) Which of the following assignments, if made by the registered nurse, would be appropriate for an LPN?
A. A 34-year old woman with low back pain scheduled for a myelogram in the afternoon.
B. A 41-year old woman in traction with a fractured femur.
C. A newly diagnosed 43-year old woman with type 1 diabetes mellitus.
D. A 56-year old man with emphysema scheduled to be discharged later today.

Nurses must be knowledgeable about specific medical & surgical complications and be watching for them in the patients. If complications are seen, the nurse must alert the physician.

3)The nurse is caring for a client who had a thyroidectomy 12 hours ago for treatment of Graves' disease. The nurse would be most concerned if which of the following was observed?
A. Blood pressure 138/82, pulse 84, respirations 16, oral temp 99 degrees F.
B. The client supports his head and neck when turning his head to the right.
C. The client spontaneously flexes his wrist when the blood pressure is obtained.
D. The client is drowsy and complains of a sore throat.

The nurse should also be aware of expected medical & surgical side effects so she can treat them directly and not alert the physician, unnecessarily.

4) A client receives 10 units of NPH insulin every morning at 8am. At 4pm, the nurse observes that the client is diaphoretic and slightly confused. The nurse should take which of the following actions first.
A. Check vital signs.
B. Check urine for glucose and ketones.
C. Give 6 oz. of skim milk.
D. Call the physician.

The nurse must be knowledgeable about the patient's condition/surgery so she can provide the necessary care and interventions to the patient.

5) A client is admitted to the hospital with a diagnosis of chronic bronchitis. He has a 10-year history of emphysema. The nurse should place him in which of the following positions?
A. Side-lying
B. Supine
C. High-Fowlers
D. Fowlers

The nurse must know expected laboratory normals and the use of the laboratory tests in order to monitor the patient's condition and alert the physician if necessary. If a lab tests comes back and the value is abnormal it is the nurse's responsibility to communicate that to the doctor. If it is not told to the physician, then, it is the nurse who is at fault.

6) The nurse is caring for a client with an acute myocardial infarction. Which of the following laboratory findings would most concern the nurse?
A. Erythrocyte sedimentation rate (ESR): 10 mm/h
B. Hematocrit (Hct): 42%
C. Creatine kinase (CK): 150 U/ml
D. Serum glucose: 100 mg/dl

The nurse is involved in educating the community in general about medical issues.

7) A parent asks why it is recommended that the second dose of the measles, mumps, and rubella (MMR) vaccine be given at 4 to 6 years of age? The nurse should explain to the parent that the second dose is given at this age for what reason?
A. If the child reaches puberty and becomes pregnant when receiving the vaccine, the risks to the fetus are high.
B. The chance of contracting the disease is much lower at this age.
C. The dangers associated with a strong reaction to the vaccine are increased at this age.
D. A serious complication from the vaccine is swelling of the joints.

The nurse is responsible for being knowledgeable about medical conditions so that she can educate patients about their specific conditions.

8) The nurse is caring for a woman at 37 weeks' gestation. The client was diagnosed with insulin dependent diabetes mellitis (IDDM) at age 7. The client states, "I am so thrilled that I will be breastfeeding my baby." Which of the following responses by the nurse is best?

A. "You will probably need less insulin while you are breastfeeding."
B. "You will need to initially increase your insulin after the baby is born."
C. "You will be able to take an oral hypoglycemic instead of insulin after the baby is born."
D. "You will probably require the same dose of insulin that you are now taking after birth."

The nurse must make appropriate room assignments so that the health of the patient, their roommate, and others is protected.

9) The nurse is caring for clients on the pediatric unit. An eight-year old client with second and third degree burns on the right thigh is being admitted. The nurse should assign the new client to which one of the following roommates?
A. A two-year old with chicken pox.
B. A four-year old with asthma.
C. A nine-year old with acute diarrhea.
D. A ten-year old with MRSA.

The nurse must be knowledgeable about matters of nutrition and its impact on medical conditions in order to provide basic dietary counseling to patients related to their specific needs.

10) The nurse is preparing discharge teaching for a client with a new colostomy. The nurse knows teaching was successful when the client chooses which of the following menu options?
A. Sausage, sauerkraut, baked potato, and fresh fruit.
B. Cheese omelet with ban muffin and fresh pineapple.
C. Pork chop, mashed potatoes, turnips, and salad.
D. Baked chicken, boiled potato, cooked carrots, and yogurt.

The nurse needs to be knowledgeable about antidotes for specific medications in order to provide for the safety of the client in case of toxicity.

11) The nurse is caring for clients on the medical unit. A client is admitted with a diagnosis of deep vein thrombosis (DVT). Admission orders include heparin 2,000 units per hour in 5% dextrose in water. The nurse should have which of the following available?
A. Propranolol (inderal)
B. Protamine zinc
C. Protamine sulfate
D. Vitamin K

The nurse must be aware of medications the patient is on and possible interactions that would affect the patient.

12) A client returns to the clinic two weeks after discharge from the hospital. He is taking wafarin sodium 2 mg PO daily. Which of the following statements, if made by the client to the nurse indicates that further teaching is necessary?
A. "I have been taking an antihistamine before bed."
B. "I take aspirin when I have a headache."
C. "I use sunscreen when I go outside."
D. "I take Mylanta if my stomach gets upset."

The nurse needs to be aware of specific physical/physiological conditions that would affect medications and be prepared to make critical decisions about the administration of those medications.

13) A client is receiving digoxin. His pulse range is normally 70 - 76 bpm. After assessing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should initially:
A. Call the physician for orders
B. Withhold the digoxin
C. Administer the digoxin
D. Notify the charge nurse

The nurse must be knowledgeable about medications in order to do accurate patient teaching about their medications.

14) A client asks the nurse how long she has to take her medicine for hypothyroidism. The nurse's response is based on the knowledge that:
A. Lifelong daily medicine is necessary.
B. The medication is expensive, and the dose can be reduced in a few months.
C. The medication can be gradually withdrawn in 1 - 2 years.
D. The medication can be discontinued after the client's thyroid-stimulating hormone level is normal.

The nurse is responsible for all nursing actions she preforms. Mindless "helping the doctor by doing what he says" as my son put it, is not an option. The nurse must double check all orders for all patients, ensuring that the treatment, test, or medication is appropriate and safe for the patient.

15) A client with acute pancreatitis has been admitted with the following physician orders. Which would the nurse question the doctor on?
A. NPO
B. Naso-gastric tube insertion
C. Morphine sulfate 5mg every 4 hours PRN pain
D. IV of D 5 1/2 NS at 125ml/hr

Lawsuits against nurses for negligence and malpractice are on the increase. Prudent nurses will stay abreast of current research and practice evidence based nursing.

Yes, we help the doctors, but nurses today are autonomous, and they take pride in their profession.

Answers: 1) a 2) b 3) c 4) c 5) c 6) c 7) a 8) a 9) b 10) d 11) c 12) b 13) b 14) a 15) c
Questions from:
NCLEX-RN Strategies for the registered nursing licensing exam 2007-2008 edition &
NCLEX-RN Exam Cram