Nursing Elites

1. A client with a new prescription for lithium carbonate for bipolar disorder is being educated by a nurse on early indications of toxicity. The nurse should include which of the following manifestations in the teachings?

• A. Constipation
• B. Polyuria
• C. Rash
• D. Tinnitus

Correct answer: B

Rationale: Polyuria is a crucial early indication of lithium toxicity. It results from the drug's effect on the kidneys, leading to increased urine output. This is a significant symptom to monitor as it can indicate potential toxicity. Constipation, rash, and tinnitus are not typically associated with early indications of lithium toxicity. Constipation is more commonly seen as a side effect of some medications, while rash and tinnitus are not specific indicators of lithium toxicity.

2. If a healthcare professional prevents intentional harm from occurring to a patient, which ethical principle is being supported?

• A. Beneficence
• B. Nonmaleficence
• C. Justice
• D. Fidelity

Correct answer: B

Rationale: The correct answer is Nonmaleficence. Nonmaleficence is the ethical principle that emphasizes the obligation to avoid causing harm intentionally. In this scenario, by preventing intentional harm to a patient, the healthcare professional is upholding the principle of nonmaleficence. Beneficence, although important, focuses on doing good and promoting well-being rather than solely preventing harm. Justice relates to fairness and equality in resource distribution, while fidelity involves being faithful and keeping promises, which are not directly applicable to the situation of preventing intentional harm to a patient.

3. You are caring for a Hispanic patient who is scheduled for surgery in the morning. A member of the surgery staff is in a hurry when she visits the patient to obtain surgical consent. You know that the patient speaks limited English and can see that he does not really understand what's being said. What is the most appropriate next action?

• A. Call a family member to interpret
• B. Consult the hospital translator to assist
• C. Allow the consent to be signed
• D. Ask the staff member to come back later

Correct answer: B

Rationale: Consulting the hospital translator is the most reliable means of ensuring accuracy in the information that the patient is receiving. Family members can be helpful, but they may have difficulty understanding the medical procedures well enough to explain them accurately and may misinterpret the message. Relying on family members could lead to misunderstandings or miscommunication. Allowing the consent to be signed without ensuring the patient's full understanding could pose risks to the patient's well-being. Asking the staff member to come back later delays the essential communication process needed before surgery. Therefore, consulting the hospital translator is the best course of action to ensure clear and accurate communication, especially in critical healthcare decisions like surgical consent.

4. A client needs to give informed consent for electroconvulsive therapy treatments. Which of the following actions should the nurse take?

• A. Explain the adverse effects the client might experience from the treatment
• B. Verify the client gave consent voluntarily for the treatment
• C. Describe the benefits of the treatment to the client
• D. Outline possible alternatives to the treatment for the client

Correct answer: B

Rationale: When obtaining informed consent for a procedure like electroconvulsive therapy, the nurse's primary responsibility is to ensure that the client has given consent voluntarily and is capable of making such a decision. While it is essential to provide information on the treatment's benefits, risks, and alternatives, the priority is to verify the client's voluntary consent. Explaining the adverse effects and describing the benefits are important steps in the informed consent process, but the critical step is to confirm the client's voluntary agreement. Outlining possible alternatives to the treatment is also important but comes after ensuring the client's voluntary consent.

5. A client has volunteered to take part in a research study. After participating for two months, he decides that he can no longer tolerate the study and decides to leave. What are the client's rights in this situation?

• A. The client has a right to be released from the study but must reimburse the researchers for charges incurred
• B. The client has a right to be released from the study without any liability
• C. The client has a right to be released from the study but is prohibited from participating in any future studies
• D. The client does not have the right to be released from the study; he must finish his participation

Correct answer: B

Rationale: When a client voluntarily participates in a research study and later decides to withdraw, they have the right to be released from the study without any liability. It is unethical to force a participant to continue in a study against their will as this violates their autonomy and personal rights. Choice A is incorrect as it suggests that the client must reimburse the researchers for charges incurred, which is not typically the case unless agreed upon beforehand. Choice C is incorrect as there is no standard practice prohibiting a participant from future studies just because they withdrew from a current one. Choice D is incorrect because participants always have the right to withdraw from a research study at any time.

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