Nursing Elites

1. A client with an aggressive form of prostate cancer declines to discuss concerns after the provider briefly discusses treatment options and leaves the room. Which of the following statements should the nurse make?

• A. “I am available to talk if you should change your mind.”
• B. “I understand you do not want to discuss it further.”
• C. “You should talk to the provider if you have more questions.”
• D. “I will be back later to discuss your concerns.”

Correct answer: A

Rationale: The nurse should offer support without pressuring the client. Stating, “I am available to talk if you should change your mind,” acknowledges the client's decision while leaving the door open for future discussions. Choice B is incorrect as it assumes the client's decision is final without offering further support. Choice C directs the client back to the provider without addressing the nurse's availability. Choice D commits to a future discussion without considering the client's current preference.

2. An 18-year-old client is admitted to the intensive care unit from the emergency room following a diving accident. The injury is suspected to be at the level of the 2nd cervical vertebra. The nurse's priority assessment should be

• A. Response to stimuli
• B. Bladder control
• C. Respiratory function
• D. Muscle strength

Correct answer: C

Rationale: Injuries at the level of the 2nd cervical vertebra can affect the phrenic nerve, leading to potential impairment of respiratory function. Assessing respiratory function is crucial as compromised breathing can quickly escalate to life-threatening situations. While response to stimuli is important, ensuring adequate oxygenation takes precedence due to the immediate threat to life. Bladder control may be affected by spinal cord injuries at higher levels, but it is not the priority in this scenario. Muscle strength is a potential consequence of cervical spinal cord injury, but assessing respiratory function is more critical in the acute phase.

3. During an assessment, a healthcare professional observes significant tenting of the skin over an older adult client's forearm. What factor should the healthcare professional primarily consider as a cause for this finding?

• A. Thin, parchment-like skin
• B. Loss of adipose tissue
• C. Dehydration
• D. Diminished skin elasticity

Correct answer: C

Rationale: Dehydration is the primary factor to consider in this scenario. Dehydration leads to decreased skin turgor and tenting, where the skin does not return to its normal position when pinched. While thin, parchment-like skin, loss of adipose tissue, and diminished skin elasticity can contribute to skin changes, they are not the primary cause of the significant tenting observed.

4. A charge nurse is assigning client care for four clients. Which of the following tasks should the nurse assign to a PN?

• A. Creating a plan of care for a client who is recovering following a stroke.
• B. Assessing a pressure injury on a client who is on bed rest.
• C. Providing nasopharyngeal suctioning for a client who has pneumonia.
• D. Teaching a client who has asthma to use a metered-dose inhaler.

Correct answer: C

Rationale: The correct answer is providing nasopharyngeal suctioning for a client who has pneumonia. This task falls within the practical nurse's scope of practice, as it involves direct patient care and basic interventions. Creating a plan of care for a client recovering from a stroke involves critical thinking and comprehensive assessment, which are typically responsibilities of registered nurses. Assessing a pressure injury requires specialized wound care knowledge, often performed by wound care specialists or registered nurses with wound care training. Teaching a client to use a metered-dose inhaler involves patient education and requires a thorough understanding of asthma management, making it more suitable for a registered nurse.

5. A female client with chronic back pain has been taking muscle relaxants and analgesics to manage the discomfort, but is now experiencing an acute episode of pain that is not relieved by this medication regime. The client tells the nurse that she does not want to have back surgery for a herniated intervertebral disk, and reports that she has found acupuncture effective in resolving past acute episodes. Which response is best for the nurse to provide?

• A. Surgery removes the disk and is the only treatment that can totally resolve the pain
• B. The medication regimen you previously used should be re-evaluated for dose adjustment
• C. Massage and hot pack treatments are less invasive and can provide temporary relief
• D. Acupuncture is a complementary therapy that is often effective for management of pain

Correct answer: D

Rationale: Acupuncture has been effective for the client previously, supporting continued use.

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