Nursing Elites

1. A licensed practical nurse tells the certified nursing assistant (CNA) staff that they will need to comply with the mandatory overtime policy that the long-term care facility has implemented. Later that day, the nurse overhears a CNA complaining about the policy and telling other CNAs that she will not work the overtime if she has made other plans after her regular shift. What is the best approach for the nurse to use in dealing with the conflict?

• A. Providing a positive reward system for the CNA to encourage working the mandatory overtime
• B. Ignoring the complaints
• C. Avoiding assigning the CNA mandatory overtime
• D. Meeting with the CNA regarding her behavior concerning the overtime policy

Correct answer: D

Rationale: In this situation, the best approach for the nurse is to meet with the CNA regarding her behavior concerning the overtime policy. Initiating a discussion is crucial to address resistance by a staff member. A face-to-face meeting allows for the verbalization of feelings, identification of problems, and the opportunity to develop strategies to solve the issue. Ignoring the complaints and avoiding assigning mandatory overtime do not tackle the root of the problem. Providing a positive reward system might offer a temporary fix but does not directly address the resistance and conflict.

2. The LPN is receiving the report on a comatose client at the start of the shift at 1500. What statement should be of most concern?

• A. The client was repositioned on his right side at 1100.
• B. The client was bathed, and the skin was assessed head-to-toe at 0900 with no abnormal findings.
• C. The client's PEG tube was changed 6 months ago.
• D. The client's indwelling urinary catheter was last changed 5 days ago.

Correct answer: D

Rationale: When caring for a comatose client, it is crucial to monitor and maintain the integrity of the indwelling urinary catheter to prevent urinary tract infections and other complications. Changing the urinary catheter less frequently than recommended increases the risk of infection. In this scenario, the most concerning issue is the prolonged duration since the last change of the indwelling urinary catheter, which poses an immediate risk to the client's health. While repositioning every 2 hours is essential to prevent skin breakdown, the most critical aspect in this case is the catheter care. Bathing and skin assessment are important for overall hygiene and skin integrity but are not as urgent as catheter care. The timing of the PEG tube change, while relevant for care planning, is not as immediate a concern as the indwelling urinary catheter status.

3. What does carrying a donor card for organ donation mean?

• A. medical care is altered to obtain organs for donation in the event of serious injuries
• B. the family or legally responsible party of a client has no decision-making authority in the event that the client is considered for organ donation
• C. a client is allowed to revoke their decision for organ donation at any time
• D. a client is considered an organ donor for multiple organs or tissues

Correct answer: C

Rationale: Carrying a donor card for organ donation signifies that an individual can decide to revoke their decision for organ donation at any point. This choice empowers the individual to change their mind regarding organ donation. The family or legally responsible party of a client still holds decision-making authority in the event that the client is considered for organ donation. When organ donation is being considered, all organs or tissues the donor wishes to donate are evaluated for donation suitability; it's not limited to just one organ or tissue. It's important to note that medical care for an individual is not altered to hasten the declaration of death for organ donation purposes; the focus is on providing immediate care and resuscitation to the individual.

4. An example of a process standard on a med-surg unit is:

• A. a procedure for changing IV tubing.
• B. a policy for staffing.
• C. the job description of the CEO (chief executive officer).
• D. a procedure for checking waveforms on a client being treated with an intra-aortic balloon pump.

Correct answer: D

Rationale: Process standards define the actions and behaviors required by staff to provide care on a med-surg unit. A procedure for changing IV tubing is a critical psychomotor skill necessary for safe and effective patient care in this setting. Choice B, a policy for staffing, pertains more to organizational management rather than specific care processes on the unit. Choice C, the job description of the CEO, delineates the responsibilities of the organization's top executive and is not a process standard for frontline staff. Choice D, a procedure for checking waveforms on a client with an intra-aortic balloon pump, is more specific to a cardiac care unit and not typically performed on a med-surg unit.

5. A client states, 'I can leave the diaphragm in place as long as I want after intercourse.' Which statement indicates to the nurse that the client needs further information on how to use the diaphragm?

• A. 'I need to reapply spermicidal cream with repeated intercourse.'
• B. 'The diaphragm needs to be filled with spermicidal cream before insertion.'
• C. 'I can leave the diaphragm in place as long as I want after intercourse.'
• D. 'The diaphragm can be inserted as long as 6 hours before intercourse.'

Correct answer: C

Rationale: The correct answer is the statement, 'I can leave the diaphragm in place as long as I want after intercourse.' This statement indicates a lack of understanding about the correct use of the diaphragm. The diaphragm must be left in place for at least 6 hours after intercourse to ensure effectiveness and reduce the risk of pregnancy. Leaving the diaphragm in place for an extended period can lead to toxic shock syndrome. Choice A is correct as spermicidal cream needs to be reapplied before each act of intercourse for optimal contraceptive efficacy. Choice B is a correct statement as the diaphragm should be filled with spermicidal cream before insertion to increase its effectiveness. Choice D is also accurate as the diaphragm can be inserted up to 6 hours before intercourse to allow time for proper placement and effectiveness.

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