Nursing Elites

1. During preoperative teaching, a client in a surgeon’s office expresses intent to prepare advance directives before surgery. Which statement by the client indicates understanding of advance directives?

• A. “I’d prefer my brother to make decisions, but I understand it must be my wife.”
• B. “I understand the surgery won’t proceed unless I fill out these forms.”
• C. “I plan to specify my wish to avoid being kept on a breathing machine.”
• D. “I will have my primary doctor review my plan before submitting it at the hospital.”

Correct answer: C

Rationale: The correct answer is C. This statement reflects the client's understanding of advance directives, as it indicates a specific preference regarding life-sustaining treatment. Advance directives enable individuals to outline their healthcare preferences, including decisions about treatments they wish to receive or avoid. Choice A mentions family members but doesn't address specific healthcare wishes; choice B focuses on the surgery rather than personal directives; choice D discusses doctor approval but lacks details about the directive itself.

2. A healthcare professional is caring for a client with a chest tube. Which observation requires immediate intervention?

• A. Constant bubbling in the suction control chamber
• B. Intermittent bubbling in the water seal chamber
• C. Drainage of 50 ml per hour
• D. Crepitus around the insertion site

Correct answer: D

Rationale: Crepitus around the chest tube insertion site may indicate subcutaneous emphysema, a serious condition that requires immediate attention. It can be a sign of an air leak in the lung or surrounding tissues. Constant bubbling in the suction control chamber is expected in a functioning chest tube system as it indicates proper suction. Intermittent bubbling in the water seal chamber is also normal, showing that the system is functioning correctly, allowing air to escape but not re-enter. Drainage of 50 ml per hour is within the expected range for chest tube output and does not require immediate intervention unless there are other concerning signs such as rapid increase or a sudden change in color or consistency.

3. A nurse in a provider's office is collecting information from an older adult who reports that he has been taking acetaminophen 500 mg/day for severe joint pain. The nurse should instruct the client that large doses of acetaminophen could cause which of the following adverse effects?

• A. Liver damage
• B. Renal failure
• C. Gastric bleeding
• D. Heart attack

Correct answer: A

Rationale: Correct Answer: Large doses of acetaminophen can cause liver damage, which is a known adverse effect of the medication. Acetaminophen is metabolized in the liver, and excessive amounts can overwhelm the liver's ability to process it, leading to hepatotoxicity. Renal failure (Choice B) is not typically associated with acetaminophen use. Gastric bleeding (Choice C) is more commonly linked to nonsteroidal anti-inflammatory drugs (NSAIDs) rather than acetaminophen. Heart attack (Choice D) is not a recognized adverse effect of acetaminophen, which primarily affects the liver when taken in large amounts.

4. A nurse is planning an education session for an older adult client who has just learned that she has type 2 diabetes mellitus. Which of the following strategies should the nurse plan to use with this client?

• A. Allow extra time for the client to respond to questions
• B. Expect the client to have difficulty understanding the information
• C. Avoid references to the client’s past experiences
• D. Keep the learning session private and one-on-one

Correct answer: A

Rationale: Corrected Choice A, allowing extra time for the client to respond to questions, is the appropriate strategy when educating an older adult with type 2 diabetes mellitus. Older adults may need additional time to process information and formulate responses. Choice B is incorrect as it assumes the client will have difficulty understanding the information, which may not be the case. Choice C is incorrect because referencing the client's past experiences can help personalize the education session. Choice D is also incorrect as keeping the learning session private and one-on-one may not be necessary for all clients and may limit the potential benefits of group education and support.

5. A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, the nurse was found asleep in a chair in the break room not during a break time. Which of the following actions should the nurse take?

• A. Alert the American Nurses Association.
• B. Fill out an incident report.
• C. Report the observations to the nurse manager on the unit.
• D. Leave the nurse alone to sleep.

Correct answer: C

Rationale: Reporting the observations to the nurse manager is the appropriate action to ensure the safety of the clients and address potential impairment. The nurse manager can take necessary steps to assess the situation and intervene if needed. Alerting the American Nurses Association (Choice A) is not necessary at this stage as the immediate concern is the safety of clients in the unit. Filling out an incident report (Choice B) may be required later, but the priority is to address the issue promptly by involving the immediate supervisor. Leaving the nurse alone to sleep (Choice D) is not a safe option as it does not address the underlying problem of potential impairment and safety concerns; it is essential to address the issue promptly to ensure patient safety.

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