Nursing Elites

1. Upon first meeting, a new nurse manager makes eye contact, smiles, initiates conversation about the previous work experience of nurses, and encourages active participation by nurses in the dialogue. Her behavior is an example of:

• A. Aggressiveness.
• B. Passive aggressiveness.
• C. Passiveness.
• D. Assertiveness.

Correct answer: D

Rationale: The correct answer is 'Assertiveness.' This nurse manager is demonstrating assertive behavior by confidently engaging with the nurses, showing interest in their work experience, and encouraging active participation. Aggressive behavior is forceful and dominating, while passive behavior is submissive and timid. Passive-aggressive behavior involves indirect manipulation or control, which is not demonstrated in this scenario.

2. When evaluating the lab work of a client in hepatic coma, which of the following lab tests is most important?

• A. blood urea nitrogen
• B. serum calcium
• C. serum ammonia
• D. serum creatinine

Correct answer: C

Rationale: When a client is in hepatic coma due to liver failure, the liver cannot metabolize amino acids completely, leading to elevated ammonia levels. Increased ammonia can cause brain-tissue irritation, worsening the coma. Therefore, monitoring serum ammonia levels is crucial in assessing the severity of hepatic coma. Choices A, B, and D are less relevant in the context of hepatic coma. Blood urea nitrogen primarily assesses kidney function, serum calcium levels are not directly related to hepatic coma, and serum creatinine is more indicative of kidney function rather than liver function in this scenario.

3. During an annual physical exam, a client is diagnosed with Benign Prostatic Hyperplasia (BPH). This client is likely to have a consult with which type of physician?

• A. gynecologist
• B. physiatrist
• C. urologist
• D. proctologist

Correct answer: C

Rationale: A client diagnosed with Benign Prostatic Hyperplasia (BPH) would typically have a consult with a urologist. Urologists specialize in urinary tract and prostatic diseases, making them the appropriate choice for managing BPH. A gynecologist focuses on diseases of the female reproductive tract, so they are not relevant in this case. A physiatrist specializes in rehabilitation care, which is not directly related to the treatment of BPH. A proctologist specializes in lower colonic digestive diseases, which are unrelated to BPH.

4. Which of the following ethnic groups is at highest risk in the United States for pesticide-related injuries?

• A. Native American
• B. Asian-Pacific
• C. Norwegian
• D. Hispanic

Correct answer: D

Rationale: Hispanic people are at the highest risk in the United States for pesticide-related injuries due to their significant representation among migrant workers in agricultural settings. Working in such environments exposes them to pesticides more frequently, thus elevating their risk compared to other ethnic groups. In contrast, Native American, Asian-Pacific, and Norwegian populations are not as commonly engaged in agricultural work involving pesticide exposure, which makes them less susceptible to pesticide-related injuries. Therefore, the correct answer is Hispanic.

5. A client has experienced a CVA with right hemiparesis and is ready for discharge from the hospital to a long-term care facility for rehab. To provide optimal continuity of care, the nurse should do all of the following except:

• A. document the current functional status
• B. have the physician fax a report to the receiving facility
• C. copy appropriate parts of the medical record for transport to the receiving facility
• D. phone a report to the facility

Correct answer: B

Rationale: To ensure optimal continuity of care for a client transitioning to a long-term care facility for rehab after a CVA, the nurse plays a crucial role in communication. Documenting the current functional status is essential for the receiving facility to plan appropriate care. Copying relevant parts of the medical record for transport provides important background information. Phoning a report directly to the facility is a direct and effective way to communicate the client's condition and care plan. However, having the physician fax a report to the receiving facility introduces an extra step that may delay essential information transfer and increase the risk of miscommunication. Therefore, it is not the optimal choice for ensuring seamless continuity of care.

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