Nursing Elites

1. When planning care for an uninsured diabetic patient, which strategy should be a priority?

• A. Obtain less expensive medications
• B. Follow evidence-based practice guidelines
• C. Assist with dietary changes as the first action
• D. Teach about the impact of exercise on diabetes

Correct answer: B

Rationale: The priority when planning care for an uninsured diabetic patient should be to follow evidence-based practice guidelines. By adhering to standardized evidence-based guidelines, the nurse can help reduce healthcare disparities among different socioeconomic groups. While obtaining less expensive medications and assisting with dietary changes are important, the primary concern should be providing care that aligns with established standards of practice. Teaching about the impact of exercise is also valuable but may not be the priority when immediate care planning for an uninsured patient is considered.

2. As a nurse, you have been assigned to take over as charge nurse without any report after the previous charge nurse fell during her shift and was taken to the emergency room. At the end of the shift, you have made the assignments for the next shift's nurses and posted them. As the nurses come in, they begin to complain that the assignments make no sense based on patient acuity. One refuses to take her assignment and threatens to go home. What could you have done to prevent their dissatisfaction?

• A. Reviewed the notes of the previous charge nurse
• B. Tried to contact the previous charge nurse in the emergency room
• C. Collaborated with the nurse manager
• D. Collaborated with the other nurses on your shift

Correct answer: D

Rationale: Collaborating with the other nurses on your shift would have permitted them to provide the most updated information regarding patient status and acuity. Requesting their input into creating assignments would have provided shared governance and assurance that the unit staffing was arranged appropriately. Reviewing the notes of the previous charge nurse might not capture the real-time changes in patient conditions. Trying to contact the previous charge nurse in the emergency room may not be feasible or timely. Collaborating with the nurse manager could be helpful, but involving the nurses directly impacted by the assignments would have been more effective in addressing their concerns and ensuring appropriate patient care.

3. A client must use a non-rebreathing oxygen mask. Which of the following statements is true regarding this type of mask?

• A. A non-rebreather can provide an FiO2 of 40%.
• B. A client should breathe through his or her mouth when using a non-rebreather.
• C. A non-rebreather offers a reservoir from which the client inhales.
• D. The mask of a non-rebreather should be changed every 3 hours.

Correct answer: A

Rationale: A non-rebreather mask is used for supplemental oxygen delivery for clients experiencing breathing difficulties. The non-rebreather mask includes a one-way valve that allows exhaled air to escape, preventing the rebreathing of carbon dioxide. The client inhales oxygenated air from a reservoir bag attached to the mask, providing high-concentration oxygen therapy. A non-rebreather mask can deliver FiO2 levels of up to 90%, making it an effective intervention for clients requiring high oxygen concentrations. Therefore, the statement that 'A non-rebreather can provide an FiO2 of 40%' is correct. Choices B, C, and D are incorrect because clients should breathe through their nose and mouth, the mask offers a reservoir for inhaling oxygen, and the mask should be assessed and potentially replaced if soiled or damaged, not routinely changed every 3 hours.

4. Which of the following reasons would be legal when considering a patient's medical record?

• A. Allowing a patient's brother to view her chart to find out her birthdate and address so that he can mail her a card
• B. Not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing
• C. Not allowing a patient to view her chart because she is behind on her payments
• D. All of the above are legal

Correct answer: B

Rationale: The correct answer is not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing. Physicians have a duty to withhold certain health information from patients if disclosing it could potentially harm the patient. In situations where revealing certain information may have a significantly negative impact on the patient's mental or physical health, healthcare providers have the legal right to withhold that information. Allowing a patient's brother to view her chart for non-medical reasons like sending a card is not a valid legal reason for disclosing patient information. Similarly, refusing access based on financial reasons is not a legal ground for restricting access to a patient's medical record as patient care should not be influenced by financial matters.

5. A nurse is required to float to another unit within the hospital where he is asked to care for a client on a ventilator. The nurse is uncomfortable with this assignment, as he has not had a ventilated client since nursing school. What is the nurse's most appropriate response?

• A. Explain to the nursing supervisor the level of discomfort and ask for a different assignment
• B. State that the client's needs are outside the nurse's scope of practice and request a different assignment
• C. Accept the assignment, asking for help when necessary
• D. Request to return to the home unit and send another nurse who can perform the job

Correct answer: A

Rationale: When floating to another unit and asked to take an assignment that falls outside a nurse's comfort zone, the nurse should notify the area supervisor of the level of discomfort and request a different assignment. Caring for ventilated clients typically falls within the scope of nursing practice; however, discomfort with the situation may not necessarily be overcome by accepting the assignment. Alternatively, the effects could be harmful to the client if the nurse is unfamiliar with this type of care. Requesting a different assignment is the most appropriate response in this situation, ensuring patient safety and the nurse's comfort level. Stating that the client's needs are outside the nurse's scope of practice (Choice B) may not be accurate, as caring for ventilated clients usually falls within the scope of nursing practice. Accepting the assignment (Choice C) without addressing the discomfort may compromise patient safety. Requesting to return to the home unit (Choice D) does not address the immediate need of caring for the ventilated client and may delay appropriate care.

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