Nursing Elites

1. A nurse is caring for a client who is unconscious and whose partner is their health care surrogate. The partner wishes to discontinue the client's feeding tube, but another family member tells the nurse that they want the client to continue receiving treatment. Which of the following responses should the nurse make?

• A. You should contact the provider about your wishes for your family member.
• B. We'll need to have the nursing supervisor review the client's advance directives.
• C. You should speak with the facility's ethics committee about your concerns.
• D. As the health care surrogate, the client's partner can make this decision.

Correct answer: D

Rationale: The correct response is D because the health care surrogate, as designated by the client, has the legal authority to make healthcare decisions on behalf of the client when they are unable to do so. This authority includes decisions about treatment continuation or withdrawal. Option A is incorrect as the family member's wishes do not override the legal authority of the health care surrogate. Option B is not the most appropriate action in this situation as the advance directives are already clear by the designation of a health care surrogate. Option C is not necessary at this stage since the health care surrogate can make the decision without involving the ethics committee.

2. You are caring for a patient who has no cognitive functioning but only basic human functions such as opening the eyes and the sleep-wake cycle. What level of consciousness does this patient have?

• A. Obtunded
• B. A persistent vegetative state
• C. Locked-in syndrome
• D. Brain death

Correct answer: B

Rationale: A persistent vegetative state is characterized by the absence of cognitive functioning while basic human functions like the sleep-wake cycle are retained. In this state, the patient shows reflex movements and basic responses to stimuli but lacks awareness or higher mental functions. Choices A, C, and D are incorrect because: A) Obtunded refers to a decreased level of consciousness, not the absence of cognitive functioning. C) Locked-in syndrome is a condition where the patient is aware and awake but cannot move or communicate due to complete paralysis of nearly all voluntary muscles except for vertical eye movements and blinking. D) Brain death is the irreversible cessation of all brain activity, including the brainstem, leading to the loss of all functions of the brain.

3. A nurse is assessing a client who is postoperative following a left leg below-the-knee amputation. Which of the following client statements indicates the potential need for a referral to an occupational therapist?

• A. I hope I can adjust to using crutches while I am recovering.
• B. I am worried about taking care of my toddler at home.
• C. I just don't think I can handle looking at my leg.
• D. I am not sure how I will pay for all the therapy I will need.

Correct answer: A

Rationale: The client's statement about adjusting to using crutches while recovering suggests a potential need for occupational therapy referral. Occupational therapists assist individuals in regaining independence in activities of daily living, including mobility aids and adaptations. Choices B, C, and D are more indicative of emotional or financial concerns and may require referrals to other healthcare professionals like counselors or financial advisors, rather than occupational therapists.

4. Round off these numbers to the nearest tenth:

• A. 5.5778 = 5.6, 1.027 = 1.0, 62.999 = 63, 55.123 = 55.1, 96.676 = 96.7
• B. 5.5778 = 5.6, 1.027 = 1.0, 62.999 = 63, 55.123 = 55.1, 96.676 = 96.7
• C. 5.5778 = 5.6, 1.027 = 1.0, 62.999 = 63, 55.123 = 55.1, 96.676 = 96.7
• D. 5.5778 = 5.6, 1.027 = 1.0, 62.999 = 63, 55.123 = 55.1, 96.676 = 96.7

Correct answer: B

Rationale: The correct answer is B. When rounding off to the nearest tenth, 1.027 becomes 1.0 because the digit in the hundredth's place is less than 5. For the other numbers, they are rounded correctly to the nearest tenth: 5.5778 = 5.6, 62.999 = 63, 55.123 = 55.1, 96.676 = 96.7. Therefore, option B is the most accurate in rounding off these numbers to the nearest tenth. Choices A, C, and D are incorrect as they do not round 1.027 to 1.0 as required when rounding to the nearest tenth.

5. Which insulin has the most rapid onset of action?

• A. Lente
• B. Lispro
• C. Ultralente
• D. Humulin N

Correct answer: B

Rationale: Lispro insulin has the most rapid onset of action among the options provided. It is a rapid-acting insulin analog that is designed to control postprandial hyperglycemia effectively. Lente insulin (Choice A) and Ultralente insulin (Choice C) are intermediate-acting insulins, which have a slower onset of action compared to Lispro. Humulin N (Choice D) is a neutral protamine Hagedorn (NPH) insulin, which is an intermediate-acting insulin, not rapid-acting like Lispro. Therefore, the correct choice is Lispro.

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