Nursing Elites

1. Major competencies for the nurse giving end-of-life care include:

• A. demonstrating respect and compassion, and applying knowledge and skills in care of the family and the client.
• B. assessing and intervening to support total management of the family and client.
• C. setting goals, expectations, and dynamic changes to care for the client.
• D. keeping all sad news away from the family and client.

Correct answer: A

Rationale: In providing end-of-life care, nurses must possess essential competencies. Demonstrating respect and compassion, along with applying knowledge and skills in caring for both the family and the client, are crucial competencies. These skills help create a supportive and empathetic environment for individuals facing end-of-life situations. Choice B is incorrect because while assessing and intervening are important, they do not encompass the core competencies required for end-of-life care. Choice C is also incorrect; although setting goals and expectations is valuable, the primary focus should be on providing compassionate care. Choice D is incorrect as withholding sad news goes against the principles of honesty and transparency in end-of-life care.

2. When planning play activities for a hospitalized school-age child, a nurse uses Erikson's theory of psychosocial development to select an appropriate activity. The nurse selects an activity that will assist the child in developing which developmental goal?

• A. A sense of industry
• B. Autonomy
• C. A sense of trust
• D. Initiative

Correct answer: C

Rationale: The correct answer is 'A sense of industry.' According to Erikson, the central task of the school-age years is the development of a sense of industry. During this stage, children engage in activities like schoolwork, crafts, chores, hobbies, and sports to develop a sense of competence and productivity. The development of trust is the primary task of infancy, autonomy is the task of toddlerhood, and initiative is the task of the preschool years. Therefore, in this scenario, focusing on fostering a sense of industry aligns with the developmental goals of a school-age child.

3. When a 17-year-old client arrives at the clinic suspecting a sexually transmitted infection, what information does the nurse provide concerning informed consent?

• A. She will need to sign an informed consent form.
• B. Her mother or father will need to be contacted for permission to treat her.
• C. A consent form is not needed if the problem is a sexually transmitted infection.
• D. Anyone over the age of 18 years may sign a consent form for her treatment.

Correct answer: A

Rationale: Informed consent is a person's agreement to allow something, such as a treatment, to be performed. A consent form is required even if the problem is a sexually transmitted infection. If the client is a minor, the minor may sign the informed consent form in specific situations, including seeking treatment for a sexually transmitted infection. In this case, the 17-year-old client is seeking examination and treatment for a sexually transmitted infection, so she will need to sign the informed consent form. Contacting her parents for permission is not required in this situation. Choice C is incorrect because a consent form is necessary regardless of the medical issue. Choice D is incorrect because the individual's age is not the determining factor; rather, it is the nature of the medical service being sought that dictates the need for informed consent.

4. A licensed practical nurse arrives at work at the long-term care center and is immediately faced with several activities that require attention. Which activity will the nurse attend to first?

• A. Task assignments for the day
• B. Stocking the medication closet
• C. A phone message from employee health services
• D. A phone message from a client's wife

Correct answer: A

Rationale: The nurse's priority should be attending to task assignments for the day. This ensures that client care can begin promptly and efficiently. Stocking the medication closet is important but can be done after ensuring task assignments are clear. Phone messages from employee health services and a client's wife, although important, can be addressed after organizing the staff for client care.

5. A nurse who recently learned she is pregnant has just received client assignments for the day. Which client assignment should the nurse question as being inappropriate?

• A. A client with metastatic cancer who is receiving a continuous infusion of intravenous morphine sulfate
• B. A client with a solid-sealed cervical radiation implant
• C. A client with diarrhea for whom enteric precautions are in effect
• D. A client for whom contact precautions have been implemented and who requires frequent wound irrigations

Correct answer: B

Rationale: The correct answer is a client with a solid-sealed cervical radiation implant. Brachytherapy involves the implantation of a sealed radiation source within the targeted tumor tissue. A client with such an implant emits radiation as long as it is in place. Pregnant nurses should not care for clients with solid-sealed radiation implants due to the potential radiation exposure risk to the fetus. Clients under enteric precautions due to diarrhea, receiving a continuous infusion of intravenous morphine sulfate for cancer pain, or requiring contact precautions and frequent wound irrigations do not pose a risk to pregnant nurses and are appropriate assignments for them. Therefore, the nurse should question the assignment involving the client with the solid-sealed cervical radiation implant as it poses a risk to the fetus.

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