Nursing Elites

1. The client is going for surgery and mentions their religious objection to blood transfusions. Which of the following responses would be most appropriate?

• A. "I can ask pastoral care to send someone to speak with you about this concern since it would not be safe to refuse a blood transfusion."?
• B. "I understand, and you have the right to refuse blood transfusions."?
• C. "While I understand, if there is excessive bleeding during surgery, we may need to transfuse blood to stabilize you."?
• D. "I have received a blood transfusion before, and I do not think you understand the risks versus the benefits of refusing this."?

Correct answer: B

Rationale: The most appropriate response is, '"I understand, and you have the right to refuse blood transfusions."? This answer shows respect for the client's autonomy and religious beliefs. It is crucial for healthcare providers to acknowledge and support a patient's decision-making regarding their care, even if it conflicts with medical advice. Option A is not ideal as it might seem dismissive of the client's beliefs. Option C introduces a potential negative outcome of refusing a blood transfusion, which could induce fear or coercion. Option D is inappropriate because it implies judgment and does not uphold the client's autonomy.

2. How many feet should separate the nurse and the source when extinguishing a small, wastebasket fire with an appropriate extinguisher?

• A. 1 foot
• B. 2 feet
• C. 4 feet
• D. 6 feet

Correct answer: D

Rationale: The nurse should stand about 6 feet from the source of the fire. Getting closer might put the nurse in danger. Choice A, 1 foot, is incorrect because it is too close to the fire and can expose the nurse to unnecessary risk. Choice B, 2 feet, is also too close to the fire and may lead to potential harm. Similarly, choice C, 4 feet, is not the ideal distance as it is still within the range of potential danger. The correct answer is D, 6 feet, which is a safe distance for the nurse to extinguish the fire effectively without risking personal safety.

3. A 10-year-old boy has been diagnosed with a congenital heart defect. Which of the following clinical signs does not indicate CHF?

• A. Increased body weight
• B. Elevated heart rate
• C. Lower extremity edema
• D. Compulsive behavior

Correct answer: D

Rationale: Compulsive behavior is not a clinical sign typically associated with congestive heart failure (CHF). CHF commonly presents with symptoms such as increased body weight due to fluid retention, elevated heart rate as the heart works harder to pump blood effectively, and lower extremity edema caused by fluid buildup. While behavioral changes can occur in response to illness, compulsive behavior is not a typical indicator of CHF. Choices A, B, and C are more commonly linked to CHF and should be monitored in patients with this condition.

4. A nurse in a medical-surgical unit overhears the nursing staff openly discussing a client and stating that the client is uncooperative and a real pain to care for. The nurse would most appropriately manage this issue by taking which action?

• A. Leaving articles about judgmental opinions in the nurses' report room
• B. Reporting the nurses' comments to administration
• C. Discouraging the judgmental comments
• D. Ignoring the comments made about the client

Correct answer: C

Rationale: Nurses must discuss clients in a professional manner and avoid using judgmental language such as 'uncooperative' or 'difficult.' When such comments and language are discouraged, fewer comments will be made. Ignoring the comments is an inappropriate option because the concern will not be addressed. Leaving articles about judgmental opinions in the nurses' report room indirectly addresses the issue, but there is no guarantee that the staff will read them. Reporting the nurses' comments to administration does not directly address the issue. The best approach for the nurse is to discourage judgmental comments directly with the staff members. Since this action is not provided in the options, discouraging judgmental comments is the most appropriate way to manage this concern.

5. A discharge planning nurse is making arrangements for a client with an epidural catheter for continuous infusion of opioids to be placed in a long-term care facility. The family prefers a facility in its neighborhood to facilitate visiting. The neighborhood facility has never cared for a client with this type of need. What is the most appropriate action by the discharge planning nurse?

• A. Arrange for immediate in-services for the long-term care facility staff on pain management using epidural catheters.
• B. Explain the situation to the client and family and seek another long-term care facility for discharge from the hospital.
• C. Encourage the family to hire private duty nurses skilled in epidural catheter pain management to allow the client to be transferred to the neighborhood facility.
• D. None of the above

Correct answer: B

Rationale: In this scenario, the priority is the safety and well-being of the client. The neighborhood facility's lack of experience in caring for a client with an epidural catheter for continuous opioid infusion raises concerns about the quality of care they can provide. Therefore, the most appropriate action for the discharge planning nurse is to explain the situation to the client and family and seek another long-term care facility that can provide the necessary care. Option A, arranging for immediate in-services, may not be feasible or timely, considering the urgent need for appropriate care. Option C, encouraging the family to hire private duty nurses, does not ensure the facility's overall capability to manage the client's complex needs. Option D, 'None of the above,' is not the best choice as the client's safety should be the priority in this situation.

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