Nursing Elites

1. A client with metastatic breast cancer refuses to participate in a clinical trial and further treatments. Her children ask the nurse to convince their mother to reconsider. How should the nurse respond?

• A. Ask the client if she fully understands the decision she has made with her children present.
• B. Discuss the success of clinical trials and ask the client to consider participating for one month.
• C. Explain to the family that they must accept their mother’s decision.
• D. Explore the client’s decision to refuse treatment and offer support.

Correct answer: D

Rationale: The correct response is to explore the client's decision to refuse treatment and offer support. In this situation, it is crucial for the nurse to respect the client's autonomy and decisions regarding her own health. By exploring the client's reasons for refusal, the nurse can better understand her perspective and provide appropriate support. Option A is incorrect as it focuses on questioning the client in front of her children, potentially pressuring her. Option B is inappropriate as it disregards the client's autonomy and tries to persuade her to participate. Option C is also incorrect as it dismisses the client's decision and fails to address the family's concerns in a supportive manner.

2. An adult male was diagnosed with stage IV lung cancer three weeks ago. His wife approaches the nurse and asks how she will know that her husband's death is imminent because their two adult children want to be there when he dies. What is the best response by the nurse?

• A. Explain that the client will start to lose consciousness and his body systems will slow down
• B. Reassure the spouse that the healthcare provider will let her know when to call the children
• C. Offer to discuss the client’s health status with each of the adult children
• D. Gather information on how long it will take for the children to arrive

Correct answer: A

Rationale: The best response for the nurse is to explain that the client will start to lose consciousness and his body systems will slow down. Providing information on the signs of impending death helps the family prepare emotionally and allows them to be present at the appropriate time. Choice B is incorrect because it does not empower the family with the knowledge they seek. Choice C is incorrect as discussing the client’s health status individually with the adult children may not address the wife's immediate concern. Choice D is incorrect as the priority should be on preparing the family for the signs of imminent death rather than focusing on logistical details.

3. Which type of wound would most likely require immediate intervention by the healthcare provider?

• A. Laceration
• B. Abrasion
• C. Contusion
• D. Ulceration

Correct answer: A

Rationale: A laceration would most likely require immediate intervention by the healthcare provider due to its deeper tissue damage, significant bleeding, and higher risk of infection compared to abrasions, contusions, and ulcerations. Lacerations often need prompt attention to control bleeding, clean the wound, and reduce the risk of infection. Abrasions are superficial wounds that usually do not require urgent attention as they tend to heal well on their own with basic wound care. Contusions are bruises that typically resolve on their own without immediate intervention. Ulcerations are open sores that may require intervention but not necessarily immediate action unless complicated by infection or other issues.

4. The healthcare provider prescribes a fluid challenge of 0.9% sodium chloride 1,000 ml to be infused over 4 hours. The IV administration set delivers 10gtt/ml. How many gtt/minute should the nurse regulate the infusion? (Enter a numeric value only. If rounding is required, round to the nearest whole number.)

• A. 42
• B.
• C.
• D.

Correct answer: A

Rationale: To calculate the rate: (1000 ml / 4 hours) = 250 ml/hour; (250 ml/hour) / (60 minutes/hour) = 4.17 ml/minute; (4.17 ml/minute) * (10 gtt/ml) = 41.7 gtt/minute, rounded to 42 gtt/minute. Therefore, the nurse should regulate the infusion at 42 gtt/minute to deliver the prescribed fluid challenge accurately. The other choices are incorrect as they do not reflect the correct calculation based on the given information.

5. A client who had a cerebrovascular accident (CVA) is paralyzed on the left side of the body and has developed a Stage II pressure ulcer on the left hip. Which nursing diagnosis describes this client’s current health status?

• A. Risk for impaired tissue integrity related to impaired physical mobility
• B. Impaired skin integrity related to altered circulation and pressure
• C. Ineffective tissue perfusion related to inability to move self in bed
• D. Impaired physical mobility related to the left-side paralysis

Correct answer: B

Rationale: The correct answer is B: 'Impaired skin integrity related to altered circulation and pressure.' This nursing diagnosis is the most appropriate as it directly addresses the Stage II pressure ulcer on the left hip, which is caused by altered circulation and pressure due to the client's left-side paralysis. Choice A is incorrect because it focuses on the risk for impaired tissue integrity rather than the current issue of impaired skin integrity. Choice C is incorrect as ineffective tissue perfusion is not the primary issue in this scenario. Choice D is incorrect as it only addresses the left-side paralysis and not the pressure ulcer or altered circulation.

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