Nursing Elites

1. A patient has been diagnosed with Guillain-Barre Syndrome. Which of the following statements is the most applicable when discussing the impairments with Guillain-Barre Syndrome with the patient?

• A. Guillain-Barre Syndrome improves in almost all cases within 5 years.
• B. Guillain-Barre Syndrome causes limited sensation in the abdominal region.
• C. Guillain-Barre Syndrome causes muscle weakness in the legs.
• D. Guillain-Barre Syndrome affects breathing in severe cases.

Correct answer: C

Rationale: The correct statement is that Guillain-Barre Syndrome causes muscle weakness in the legs. This muscle weakness typically starts in the legs and can progress to the upper body. Choice A is incorrect as while most cases do improve, the recovery time can vary. Choice B is incorrect as Guillain-Barre Syndrome primarily affects muscle weakness rather than sensation. Choice D is incorrect as severe cases of Guillain-Barre Syndrome can lead to respiratory muscle weakness, impacting breathing.

2. A pregnant Asian client who is experiencing morning sickness wants to take ginger to relieve the nausea. Which of the following responses by the nurse is appropriate?

• A. "I will call your physician to see if we can start some ginger."?
• B. "We don't use home remedies in this clinic."?
• C. "Herbs are not as effective as regular medicines."?
• D. "Just eat some dry crackers instead."?

Correct answer: A

Rationale: The correct response is appropriate as it demonstrates cultural sensitivity. Ginger is commonly used to alleviate nausea, particularly in Asian cultures. Contacting the physician to discuss the use of ginger ensures the client's safety and respects their preferences. Choices B and C are incorrect as they disregard the client's request and fail to acknowledge their cultural beliefs. Choice D is incorrect because it does not address the client's desire to use ginger for relief.

3. Which is an example of a sentinel event?

• A. The terminally ill client is referred to hospice and dies 3 months later.
• B. A client receives an unordered mammogram which reveals a small cyst.
• C. A client with a laceration to the knee requiring 4 sutures falls when getting up unassisted after being instructed to remain in bed.
• D. A client scheduled for knee replacement surgery had an above-the-knee amputation performed.

Correct answer: D

Rationale: Yes! A sentinel event is an unexpected occurrence causing death or serious injury. In this case, a client who was scheduled for knee replacement surgery but had an above-the-knee amputation performed instead represents a sentinel event as it resulted in serious harm that was not intended. The other choices do not meet the criteria for a sentinel event. Choice A describes a natural progression for a terminally ill client, choice B shows an incidental finding from a test, and choice C involves a preventable fall leading to an injury but not a sentinel event.

4. An RN on your unit has had an argument with the family of a client regarding the way in which the RN has changed the client's dressing. The family is adamant that the dressing change was performed incorrectly. The RN insists that sterile technique was observed. As an RN manager, what is the best response?

• A. Meet with the family member and the RN to discuss the disagreement regarding the dressing change.
• B. Talk to the family member and assure them that the nurse followed the hospital procedure.
• C. Discuss the dressing change procedure with the RN and compare it to a current textbook.
• D. Change the RN's assignment the next day to another client.

Correct answer: A

Rationale: When conflict occurs, it is best to meet with both parties together to discuss the problem. This approach allows each party to hear what the other is saying and prevents the RN manager from being caught in the middle. By facilitating a discussion between the family member and the RN, they can work together to find a resolution or the manager can mediate. This promotes open communication, understanding, and collaboration. Option A is the correct choice because it emphasizes addressing the conflict directly and seeking a mutual understanding. Option B is incorrect because just assuring the family member may not address the underlying issues. Option C is incorrect as it does not involve the family member in the resolution process. Option D is inappropriate as it doesn't address the conflict but rather avoids it by changing the RN's assignment.

5. A client complaining of chest pain is prescribed an intravenous infusion of nitroglycerin (Nitro-Bid). After the infusion is initiated, the occurrence of which symptom warrants the nurse discontinuing an intravenous infusion of nitroglycerin?

• A. Frontal headache
• B. Orthostatic hypotension
• C. Decrease in intensity of chest pain
• D. Cool clammy skin

Correct answer: D

Rationale: The correct answer is 'Cool clammy skin.' This assessment finding indicates decreased cardiac output that could result from excessive vasodilation. Cool clammy skin is a sign of poor perfusion, suggesting that the blood pressure might be dropping too low. Discontinuing the nitroglycerin infusion is crucial to prevent further complications. Choice A, 'Frontal headache,' is a common side effect of nitroglycerin but not a reason to discontinue the infusion unless severe or persistent. Choice B, 'Orthostatic hypotension,' may occur as a side effect of nitroglycerin but does not necessarily warrant discontinuation unless severe. Choice C, 'Decrease in intensity of chest pain,' is actually an expected therapeutic response to nitroglycerin and indicates improved myocardial perfusion, so it is not a reason to stop the infusion.

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