Nursing Elites

1. After a needle stick occurs while removing the cap from a sterile needle, which action should the nurse take?

• A. Complete an incident report.
• B. Select another sterile needle.
• C. Disinfect the needle with an alcohol swab.
• D. Notify the supervisor of the department immediately.

Correct answer: B

Rationale: After a needle stick, the needle is considered contaminated and should be discarded. The nurse should select another sterile needle to use. Completing an incident report is not necessary in this situation because the needle was sterile when the nurse was stuck and not in contact with any other person's body fluids. Notifying the supervisor immediately is not required as the situation can be managed by selecting a new needle. Disinfecting the needle with an alcohol swab is not recommended as it does not meet the standards of safe practice and infection control.

2. A client who has multiple sclerosis is admitted to the hospital with increasingly frequent and severe exacerbations. One day, the client's partner confides to the nurse, 'Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home.' After listening to the partner's concerns, which response would the nurse make?

• A. 'Joining a support group of people who are coping with this situation may be helpful.'
• B. 'You may be able to decrease your feelings of guilt by seeking counseling.'
• C. 'It would be helpful if you became involved in volunteer work at this time.'
• D. 'I recognize it's hard to deal with, but try to remember that this, too, shall pass.'

Correct answer: A

Rationale: Joining a support group of individuals facing similar circumstances can provide valuable support and the opportunity to share experiences, making it the most appropriate response. The response suggesting counseling to decrease feelings of guilt is premature because the partner did not directly express guilt and it may not be the most immediate need. Suggesting involvement in volunteer work at this time fails to address the partner's current emotional distress and may come across as dismissive. Offering false reassurance by stating 'this, too, shall pass' does not validate the partner's feelings and minimizes the seriousness of their concerns.

3. The client has a new colostomy. Which client outcome is most important for achievement of long-range goals associated with adjusting to a new colostomy?

• A. Mastery of colostomy care techniques
• B. Readiness to accept an altered body function
• C. Awareness of community resources available
• D. Understanding necessary dietary modifications

Correct answer: B

Rationale: The most crucial client outcome for successful adjustment to a new colostomy is the readiness to accept an altered body function. Acceptance of changes in body image and function is essential to facilitate mastery of colostomy care techniques and optimal utilization of community resources. Without readiness to accept the altered body function, the client may not be open to learning and adopting necessary changes, hindering the achievement of long-term goals. Understanding dietary modifications, while important, is secondary to the fundamental acceptance of the altered body function in the process of adjusting to a new colostomy.

4. The nurse who is preparing to give an adolescent client a prescribed antipsychotic medication notes that parental consent has not been obtained. Which action should the nurse take?

• A. Review the chart for a signed consent for medication administration.
• B. Get the guardian's permission to give the medication.
• C. Do not give the medication and document the reason.
• D. Complete an incident report and notify the supervisor.

Correct answer: C

Rationale: In this scenario, the correct action for the nurse to take is not to administer the medication and document the reason. Since the adolescent client is a minor, parental or guardian consent is required for medical treatment, including medication administration. Option A, reviewing the chart for a signed consent for medication administration, is not the appropriate action in this situation as the focus is on parental consent for the client. Option B is incorrect because obtaining the health care provider's permission does not replace the need for parental consent for a minor. Option D, completing an incident report and notifying the supervisor, is unnecessary as there is no adverse event to report; the key concern is the lack of parental consent for medication administration.

5. When a client who has had a mastectomy sees her incision for the first time, she exclaims, 'I look horrible! Will it ever look better?' Which response would the nurse provide?

• A. 'You seem shocked by the way you look now.'
• B. 'Now that the tumor is gone, the area will heal quickly.'
• C. After it heals, others won't even know you had surgery.'
• D. 'You will feel better about it when the swelling subsides.'

Correct answer: A

Rationale: The correct response, 'You seem shocked by the way you look now,' acknowledges the client's feelings and provides an opportunity for the client to express emotions freely. This reflection of feelings may help promote eventual acceptance of body image changes. Choices B, C, and D provide false reassurance and negate the client's feelings. Saying that the area will heal quickly now that the tumor is gone dismisses the client's concerns. Similarly, stating that others won't know about the surgery or that the client will feel better once the swelling subsides does not address the client's current emotional state and may undermine trust in the nurse-client relationship.

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