Nursing Elites

1. During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis?

• A. brain
• B. bone
• C. liver
• D. mediastinum

Correct answer: C

Rationale: In cases of adenocarcinoma of the rectum with positive peritoneal lymph nodes, the most likely site of metastasis is the liver. Colon tumors commonly spread through the lymphatics and portal vein to the liver. While metastasis to the brain, bone, or mediastinum is possible, the liver is typically the first to be affected due to the anatomical pathways involved in colorectal cancer metastasis. Therefore, the correct answer is the liver. Metastasis to the brain, bone, or mediastinum would be less likely at this stage of colorectal cancer progression.

2. A graduate nurse hired to work in a medical unit of a hospital is attending an orientation session. The nurse educator, discussing care maps, asks the graduate nurse whether she understands how a care map is used. Which response indicates understanding?

• A. The care map outlines the day-to-day expected outcomes of care and the outcomes anticipated at discharge
• B. The care map is a plan that is used only by the nurse to provide client care
• C. The care map is a standard plan, rather than an individualized one, that is developed strictly by a nurse and used for a client with a particular diagnosis
• D. The care map is developed by a nurse and identifies nursing diagnoses

Correct answer: A

Rationale: The correct answer is A. A care map, also known as a critical pathway, outlines the day-to-day expected outcomes of care and the outcomes anticipated at discharge or the end of a treatment phase. It includes clinical assessments, treatments, dietary interventions, activity therapies, client education, and discharge planning. While it may identify nursing diagnoses, a care map is developed by all disciplines caring for the client type and is used by the interdisciplinary team, not just the nurse alone. Choice B is incorrect because a care map is not solely for the nurse but for the entire interdisciplinary team. Choice C is incorrect as care maps are individualized plans developed by the interdisciplinary team, not just by a nurse. Choice D is incorrect as a care map is not solely about nursing diagnoses but encompasses a comprehensive plan of care.

3. A health care provider asks the nurse caring for a client with a new colostomy to request the hospital's stoma nurse to visit the client and assist with colostomy care. The nurse initiates the consultation, understanding that the stoma nurse will be able to influence the client because of which type of power?

• A. Expert power
• B. Referent power
• C. Coercive power
• D. Reward power

Correct answer: A

Rationale: Power is the ability to influence others to achieve goals. Expert power results from knowledge and skills that one possesses that are needed by others. In this scenario, the stoma nurse's expertise in colostomy care gives them the ability to influence the client effectively. Reward power is based on the ability to grant rewards and favors, which is not applicable in this situation. Coercive power is based on fear and the ability to punish, which is not the case in seeking assistance for colostomy care. Referent power results from followers' desire to identify with a powerful person, which is not the primary influence in this context.

4. Which of the following medications might cause upper-gastrointestinal (UGI) bleeding?

• A. Cardizem (diltiazem)
• B. Naprosyn (naproxen)
• C. Elavil (amitriptyline)
• D. Corgard (nadolol)

Correct answer: C

Rationale: Naprosyn (naproxen) is known to cause upper-gastrointestinal (UGI) bleeding due to its effects on the stomach lining. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the stomach and increase the risk of UGI bleeding. On the other hand, Cardizem (diltiazem), Elavil (amitriptyline), and Corgard (nadolol) are not typically associated with UGI bleeding. Cardizem is a calcium channel blocker used for hypertension and angina, Elavil is a tricyclic antidepressant, and Corgard is a beta-blocker used for hypertension.

5. A nurse is supervising a new nursing graduate in various procedures. Which action by the new nursing graduate constitutes a negligent act?

• A. Giving a verbal report to the nurse on the oncoming shift
• B. Checking neurological signs in a client with a head injury
• C. Contacting a healthcare provider about a change in a client's blood pressure
• D. Using clean gloves to change a gastrostomy tube dressing

Correct answer: D

Rationale: Negligent acts in nursing include various errors that can harm the client, such as medication errors, intravenous therapy errors, burns, falls, failure to use aseptic technique, failure to provide adequate monitoring, and failure to report significant changes in a client's condition. In this scenario, using clean gloves to change a gastrostomy tube dressing is a negligent act because sterile gloves should be used when changing a dressing over broken skin. Choices A, B, and C are not negligent acts as they involve appropriate nursing actions: giving a verbal report, checking neurological signs, and contacting a healthcare provider about a change in a client's blood pressure.

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