Nursing Elites

1. Examples of preservation of self-integrity include all of the following except:

• A. Using assistive equipment to move bariatric clients
• B. Participating in wellness programs
• C. Accepting the challenge of caring for clients with oppositional beliefs or practices
• D. Using hand hygiene and personal protective equipment

Correct answer: C

Rationale: Preservation of self-integrity involves actions that support the nurse's well-being and ethical standards. Using assistive equipment to move bariatric clients and practicing hand hygiene and personal protective equipment are essential aspects of maintaining physical health and safety, contributing to self-care. Participating in wellness programs further enhances self-care by promoting overall well-being. However, accepting the challenge of caring for clients with oppositional beliefs or practices can be emotionally taxing and may compromise a nurse's self-integrity if it leads to significant moral distress or ethical conflicts. In such situations, it is important for nurses to prioritize their well-being and ethical values by seeking alternative solutions or support.

2. A group of nurses who work on the quality assurance council of a unit have gathered to discuss ideas about how to educate their coworkers about Joint Commission requirements. Each of the nurses gives ideas, which are listed together without initial criticism. Eventually, all ideas on the list will be discussed as to their validity. This activity is known as:

• A. Optimizing
• B. Satisficing
• C. Brainstorming
• D. Centralizing

Correct answer: C

Rationale: Brainstorming is the process in which group members generate ideas without immediate criticism or evaluation. This allows for a free flow of creative suggestions. The ideas are then listed together for consideration and discussion of their validity at a later stage. Optimizing, although related to improving efficiency, does not specifically address the initial idea generation process. Satisficing refers to accepting a satisfactory or 'good enough' solution rather than seeking the best possible option, which is not reflective of the scenario described. Centralizing typically refers to consolidating decision-making authority rather than the collaborative idea generation process seen in brainstorming.

3. Jack is a 2-month-old with a diagnosis of spinal muscular atrophy (SMA) type I. He has been admitted to the hospital for progressive respiratory difficulty. His parents have been informed that if he is not placed on ventilatory support, he will continue to decompensate and die of respiratory failure. Jack's physician discusses the poor prognosis of Jack's condition, and tells the parents that he will not be able to be removed from ventilatory support once it is initiated, due to his progressive neurological disease. After much discussion, the parents have decided to decline ventilatory support, agree to a do not resuscitate (DNR) order, and request hospice care for Jack. Another parent heard them discussing Jack's situation in the waiting room and says she could never do that to her baby. What is the most appropriate response to this parent?

• A. You never know what you'll do until you're in that situation.
• B. I can't discuss another patient's situation.
• C. They have been through too much already.
• D. You can contact administration with your concerns.

Correct answer: B

Rationale: In healthcare settings, privacy regulations prevent professionals from discussing patient situations with individuals not involved in that patient's care. Maintaining patient confidentiality is crucial to protect sensitive information. In this scenario, sharing details about Jack's situation with the parent who overheard the conversation would breach confidentiality. It is important to handle such situations delicately, especially in emotional environments like intensive care unit waiting rooms. While empathy and support are essential, it is equally crucial to respect patient privacy and confidentiality. Therefore, responding with 'I can't discuss another patient's situation' is the most appropriate and professional response in this context.

4. You are turning your patient in bed and notice that a confused and lethargic patient had loose car keys and lipstick in the bed and had been lying on them. What is this person at risk for due to all three of these factors: confusion, lethargy, and items in the bed?

• A. Falls
• B. Skin breakdown
• C. Apnea
• D. Lack of mobility

Correct answer: B

Rationale: This patient is at great risk for skin breakdown due to the presence of three specific risk factors: confusion, lethargy, and items in the bed. While confusion puts the patient at risk for falls, confusion and lethargy together may lead to a lack of mobility. However, skin breakdown is the primary concern in this scenario as it is associated with all three risk factors - confusion, lethargy, and the presence of items in the bed. Therefore, the correct answer is 'Skin breakdown'.

5. A client is refusing to undergo any more treatments in the hospital and wants to leave against medical advice. When the nurse requests the client to sign an AMA order, the client refuses and leaves. What is the next action of the nurse?

• A. Call security to hold the client until he signs the order
• B. Notify the physician to convince the client to stay
• C. Speak with the client's spouse to persuade him to stay
• D. Allow the client to leave and document the refusal in his chart

Correct answer: D

Rationale: The nurse cannot force the client to stay in the hospital to receive treatment or to sign an AMA order. It is essential to respect the client's autonomy and decision-making capacity. While involving security or pressuring the client through the physician or spouse may seem like options, they are not appropriate in this situation. The nurse should allow the client to leave if they are competent to make that decision, document the refusal in the client's chart to ensure all actions are appropriately documented, and follow institutional policies for patients leaving against medical advice.

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