When calculating a 1-minute APGAR, the nurse evaluates the following assessment data: Heart rate 120 BPM; strong cry; well-flexed; reflex-crying: body pink; acrocyanosis present in hands and feet.

In view of these findings, the nurse should assign an APGAR score of:

Choice A rationale

While clients with Cushing's syndrome may experience fatigue due to elevated cortisol levels affecting sleep patterns and muscle catabolism, clustering activities only in the morning may not adequately address the fluctuating energy levels or provide sufficient rest periods throughout the day. A more balanced approach involving rest periods and activity modification throughout the day is generally more beneficial.

Choice B rationale

Clients with Cushing's syndrome often experience fluid retention and edema due to the mineralocorticoid effects of excess cortisol. Therefore, increasing fluid intake would exacerbate fluid overload rather than alleviate symptoms. Fluid restriction and diuretic therapy may be necessary to manage fluid balance and prevent complications like hypertension and heart failure.

Choice C rationale

Cushing's syndrome is characterized by endogenous overproduction of cortisol, meaning the body already produces too much. Requesting a medical prescription for cortisol would further elevate cortisol levels, worsening the client's symptoms and potentially leading to adrenal crisis if exogenous cortisol is administered in addition to already elevated endogenous levels. Management focuses on reducing cortisol.

Choice D rationale

Assessing daily weights is crucial for clients with Cushing's syndrome due to the propensity for fluid retention and weight gain caused by increased mineralocorticoid activity of cortisol. Daily weights provide an objective measure of fluid balance and can indicate exacerbation or improvement of edema, helping guide interventions and monitor treatment effectiveness. Normal weight fluctuation should be within 1-2 kg in 24 hours.

Choice A rationale

Implementing punitive measures for staff involved in errors can create a culture of fear, discouraging the reporting of errors and near misses. This inhibits the identification of systemic issues and prevents thorough investigation, ultimately hindering effective quality improvement. A blame-free environment is crucial for fostering open communication and learning from mistakes.

Choice B rationale

Providing additional training on medication safety protocols enhances nurses' knowledge and adherence to best practices. This directly addresses potential knowledge deficits or skill gaps that contribute to errors, improving medication administration techniques and promoting a safer environment for patients. Education reinforces critical safety principles and reduces variability in practice.

Choice C rationale

Removing nurses who make errors from direct patient care without proper investigation and support can be demoralizing and does not address the underlying systemic issues contributing to the errors. It can lead to staff shortages and a negative work environment, potentially increasing the risk of errors among remaining staff due to increased workload and stress.

Choice D rationale

Encouraging staff to report near misses without fear of punishment promotes a just culture. Near misses offer valuable insights into potential system failures and opportunities for proactive intervention before actual harm occurs. This fosters a learning environment where safety concerns are openly discussed and addressed, leading to system-wide improvements.

Choice E rationale

Conducting a root cause analysis of reported errors is a systematic process to identify the fundamental reasons for errors, not just the superficial symptoms. This in-depth investigation helps uncover system vulnerabilities, process flaws, or environmental factors that contribute to adverse events, enabling the development of targeted and effective interventions.

Choice F rationale

Auditing medication administration practices regularly provides objective data on adherence to protocols and identifies areas for improvement. This allows for continuous monitoring of performance, detection of emerging issues, and evaluation of the effectiveness of implemented interventions. Regular audits are essential for sustaining quality improvements and ensuring ongoing patient safety.