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. A 27-year-old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign staff to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is hyperactive and may engage in injurious activities, setting realistic limits to the client's behavior is crucial to ensure safety. A quiet environment with firm and consistent limits helps in managing the client's behavior effectively. While repeating verbal instructions can be helpful due to the client's distractibility, it is not the priority compared to setting limits for safety concerns. Allowing the client to express feelings is important, but it should be done through non-destructive methods. Assigning staff to be with the client at all times is not realistic or feasible in the clinical setting and does not address the core issue of managing the client's behavior and ensuring safety.

3. When teaching a Vietnamese patient who has been treated for pneumonia and needs to complete her antibiotic regimen at home, what is an important cultural component to consider?

• A. Cupping will help to pull toxins from the body
• B. Coining will help to release the wind or bad energy from the body
• C. Once symptoms disappear there is no longer an illness
• D. Most households consist of at least 3 generations

Correct answer: C

Rationale: The correct answer is 'Once symptoms disappear there is no longer an illness'. In Vietnamese culture, there is a belief that once symptoms go away, the illness is no longer present and does not require further treatment. This is crucial to understand when educating Vietnamese patients about completing their antibiotic regimen. Choices A and B (cupping and coining) are traditional Vietnamese healing practices that are not directly related to completing antibiotic therapy. Choice D, about households consisting of multiple generations, is not directly relevant to the completion of antibiotic treatment for pneumonia in this context.

4. Which nursing intervention is most appropriate to maintain the patency of a client's nasogastric tube?

• A. Maintain a constant connection to low-intermittent suction
• B. Irrigate the tube as per physician's order
• C. Suction the mouth and nose every shift
• D. Perform a daily fecal occult blood sample

Correct answer: B

Rationale: The correct answer is to irrigate the tube as per physician's order. A client with a nasogastric tube is at risk of the tube kinking or clotting off, which can lead to complications such as abdominal distention or vomiting. To ensure the patency of the tube, the nurse should follow the physician's orders and facility policy to irrigate the tube with water or a solution as needed. Maintaining a constant connection to low-intermittent suction (Choice A) is not typically done to maintain tube patency. Suctioning the mouth and nose every shift (Choice C) is not directly related to maintaining nasogastric tube patency. Performing a daily fecal occult blood sample (Choice D) is unrelated to maintaining the patency of a nasogastric tube.

5. Richard is a 72-year-old with stage 4 lung cancer who has been admitted to the hospital for pneumonia. He is alert and oriented and states he would like to sign a do not resuscitate (DNR) order. His wife enters the room after he has signed it and is very upset that he has made this decision without discussing it with her. She wants to know what she can do to get the DNR reversed. What should your first response be?

• A. Contact the unit manager to talk with her
• B. Contact the hospital's attorney to discuss with her
• C. Try to talk Richard out of his decision
• D. Offer caring support for both parties

Correct answer: D

Rationale: The correct response in this situation is to offer caring support for both parties. Richard, being alert and oriented, has the right to make his own decisions, including signing a do not resuscitate (DNR) order. It is important to respect his autonomy while also acknowledging his wife's feelings. By offering caring support, the nurse can facilitate a discussion between Richard and his wife, helping them navigate their emotions and decisions. Contacting the unit manager or hospital's attorney would not be appropriate as the initial response. These actions may escalate the situation and are not focused on addressing the emotional needs of the couple. Trying to talk Richard out of his decision would disregard his autonomy and right to make choices about his own care, which goes against ethical principles of patient autonomy and informed decision-making.

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