Nursing Elites

1. A client with stage IV lung cancer is 3 days postoperative following a wedge resection. The client states, “I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my child’s wedding.” Based on the Kubler-Ross model, which stage of grief is the client experiencing?

• A. Anger
• B. Denial
• C. Bargaining
• D. Acceptance

Correct answer: C

Rationale: The client is in the bargaining stage of grief according to the Kubler-Ross model. In this stage, individuals negotiate for more time to achieve specific goals or fulfill desires. The client's statement about quitting smoking to attend their child's wedding reflects this bargaining behavior. Anger (choice A) is characterized by frustration and resentment, denial (choice B) involves avoidance of reality, and acceptance (choice D) signifies coming to terms with the situation, none of which align with the client's current mindset of bargaining.

2. Which statement best describes time management strategies applied to the role of a nurse manager?

• A. Schedule staff efficiently to cover the needs of the managed unit
• B. Assume a fair share of direct client care to set an example
• C. Set daily goals with a prioritization of tasks
• D. Delegate tasks to reduce workload associated with direct care and meetings

Correct answer: C

Rationale: Setting daily goals and prioritizing tasks is crucial for effective time management as a nurse manager. This approach helps in organizing and focusing on the most important responsibilities, ensuring that key tasks are completed efficiently. Choice A is incorrect as scheduling staff efficiently, while important, is more related to staffing management than direct time management strategies. Choice B is incorrect as assuming direct client care does not necessarily align with effective time management strategies for a nurse manager, as their primary role is overseeing and coordinating care. Choice D, while delegation is a key aspect of time management, the emphasis on reducing workload specifically associated with direct care and meetings may not always be the primary focus of a nurse manager's time management strategies.

3. What action should the nurse include in the plan of care for a postoperative client with a history of poor nutritional intake who needs care for wound healing?

• A. Provide a protein intake of 1.5 g/kg of body weight per day.
• B. Increase carbohydrate intake to 50% of daily calories.
• C. Administer high-dose vitamin supplements.
• D. Ensure a daily intake of 1000 calories.

Correct answer: A

Rationale: To promote wound healing in a postoperative client with poor nutritional intake, the nurse should include a protein intake of 1.5 g/kg of body weight per day in the plan of care. Proteins are essential for tissue repair and wound healing. Increasing carbohydrate intake or administering high-dose vitamin supplements may not directly promote wound healing. Ensuring a daily intake of 1000 calories may not provide adequate nutrients for optimal wound healing.

4. A nurse is caring for a client who is postoperative and has signs of hemorrhagic shock. When the nurse notifies the surgeon, he directs her to continue measuring the client's vital signs every 15 minutes and call him back in 1 hour. From a legal perspective, which of the following actions should the nurse take next?

• A. Document the provider's directive in the medical record
• B. Notify the nursing manager
• C. Consult the facility's risk manager
• D. Complete an incident report

Correct answer: B

Rationale: In this scenario, the nurse is facing a critical situation with a client showing signs of hemorrhagic shock. The surgeon's directive of waiting for an hour without providing immediate intervention poses a risk to the client's well-being. The nurse should prioritize the client's safety and advocate for timely and appropriate care. Notifying the nursing manager is the correct action as it activates the chain of command to ensure that the client receives the necessary care promptly. Documenting the provider's directive, consulting the risk manager, or completing an incident report are not the immediate actions needed to address the client's deteriorating condition and ensure patient safety.

5. A client scheduled for abdominal surgery reports being worried. Which of the following actions should the nurse take?

• A. Offer information on a relaxation technique and ask if the client is interested in trying it.
• B. Request a social worker to see the client to discuss meditation.
• C. Attempt to use biofeedback techniques with the client.
• D. Tell the client many people feel the same way before surgery and to think of something else.

Correct answer: A

Rationale: Offering relaxation techniques addresses the client's immediate concern by providing a proactive approach to managing anxiety. It shows empathy and offers a practical solution. Requesting a social worker for meditation (Choice B) may not be the most direct response to the client's immediate worry. Attempting biofeedback (Choice C) may not be suitable without the client's interest or consent. Telling the client to think of something else (Choice D) dismisses the client's feelings and does not provide constructive support.

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