Nursing Elites

1. Which of the following indicates a hazard for a client on oxygen therapy?

• A. A 'No Smoking' sign is on the door.
• B. The client is wearing a synthetic gown.
• C. Electrical equipment is grounded.
• D. Matches are removed.

Correct answer: B

Rationale: The correct answer is that the client is wearing a synthetic gown. A synthetic gown might generate sparks of static electricity, which can be a fire hazard, especially in the presence of oxygen. Clients on oxygen therapy should wear cotton gowns to minimize the risk of fire. The other options are not hazards for a client on oxygen therapy: having a 'No Smoking' sign on the door promotes safety by preventing smoking, ensuring electrical equipment is grounded reduces the risk of electrical hazards, and removing matches decreases the risk of fire hazards.

2. What information does the healthcare provider remember regarding do-not-resuscitate (DNR) orders in this scenario?

• A. That a DNR order may be written by a healthcare provider
• B. That everything possible must be done if the client stops breathing
• C. That medications only may be given to the client if the client stops breathing
• D. That life support measures will have to be implemented if the client stops breathing

Correct answer: A

Rationale: In a situation where a client has no family members and the client's wife is mentally incompetent, the healthcare provider may write a DNR order if it is deemed medically certain that resuscitation would be futile. A DNR order is a medical directive that instructs healthcare providers not to perform CPR if a patient's heart stops or if the patient stops breathing. Option A is correct because a DNR order can indeed be issued by a healthcare provider under certain circumstances, as it is a medical decision. Options B, C, and D are incorrect as they do not accurately reflect the concept of DNR orders and the decision-making process involved in such situations.

3. 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.

4. Which of the following is not an advanced directive?

• A. informed consent
• B. living will
• C. durable power of attorney for health care
• D. health care proxy

Correct answer: A

Rationale: Informed consent is the process of obtaining permission from a patient before conducting a healthcare intervention. It is not considered an advanced directive. A living will is a legal document that outlines a person's preferences for medical treatment if they are unable to communicate. A durable power of attorney for health care designates a person to make medical decisions on behalf of the patient. A health care proxy, which is another term for a durable power of attorney for health care, also involves appointing someone to make healthcare decisions for an individual if they become unable to do so. Therefore, the correct answer is 'informed consent,' as it is not an advanced directive but rather a different aspect of patient care.

5. A nurse working the 7 a.m. to 3 p.m. shift is reviewing the records of the assigned clients. Which client should the nurse assess first?

• A. A client scheduled for hemodialysis at 10 a.m.
• B. A client scheduled for contrast computed tomography (CT) at noon.
• C. A client scheduled for a nuclear scanning procedure at 10 a.m.
• D. A client scheduled for hydrotherapy for the treatment of a burn injury at 10:30 a.m.

Correct answer: A

Rationale: The correct answer is the client scheduled for hemodialysis at 10 a.m. This client needs immediate assessment before the procedure, which may take up to 5 hours. The nurse should ensure the client is physically and emotionally prepared, check for fluid overload by assessing weight and lung sounds, review vital signs, and laboratory test results. The other clients described in the options have needs that are not as urgent. The client scheduled for a nuclear scanning procedure at 10 a.m. may require information reinforcement and increased fluid intake before the procedure. The client scheduled for hydrotherapy for the treatment of a burn injury at 10:30 a.m. may need pain medication administered 30 minutes prior to the therapy. The client scheduled for a contrast CT at noon may need procedure information reinforcement and a special contrast preparation just before the procedure.

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