Nursing Elites

1. A nurse is planning to administer an oral antibiotic to a client with a communicable disease. The client refuses the medication and tells the nurse that the medication causes abdominal cramping. The nurse responds, 'The medication is needed to prevent the spread of infection, and if you don't take it orally I will have to give it to you in an intramuscular injection.' Which statement accurately describes the nurse's response to the client?

• A. The nurse is justified in administering the medication by way of the intramuscular route because the client has a communicable disease.
• B. The nurse could be charged with assault.
• C. Assault is an intentional threat to bring about harmful or offensive contact. If a nurse threatens to give a client a medication that the client refuses or threatens to give a client an injection without the client's consent, the nurse may be charged with assault. Therefore, the nurse is not justified in administering the medication. Battery is any intentional touching without the client's consent.
• D. The nurse will be justified in administering the medication by the intramuscular route once a prescription has been obtained from the health care provider.

Correct answer: C

Rationale: The correct answer explains the concept of assault, which is an intentional threat to bring about harmful or offensive contact. In the scenario provided, the nurse's statement about administering the medication via an intramuscular injection without the client's consent constitutes a threat, potentially falling under the definition of assault. Choice A is incorrect because the nurse's action is not automatically justified solely by the client having a communicable disease. Choice D is also incorrect because even with a prescription, the nurse cannot administer the medication without the client's consent. Choice C provides a detailed explanation distinguishing assault from battery, which helps in understanding the legal implications of the nurse's response in this situation.

2. A nurse discharge planner is preparing a client for discharge from an acute care setting. The nurse assesses that skilled home care services are clinically indicated. This assessment is based on all of the following indicators except:

• A. the client has been admitted to the hospital three times in the last 2 months.
• B. the client has a Foley catheter.
• C. the client's family is available to care for him 24 hours a day.
• D. the client is ordered to continue IV antibiotics 5 days post discharge.

Correct answer: V

Rationale: Family availability to provide care and assistance is not an indicator for skilled home care services. In fact, the nurse might see an opportunity for family education to meet the client's needs so that less community support is needed. This should be discussed and negotiated with the family. Frequent hospital readmissions indicate that the client has not been able to manage either due to condition instability or lack of care needs being met, which is a red flag for home care services to monitor and meet those needs appropriately. A Foley catheter requires home health care due to infection potential and care requirements. IV antibiotics also necessitate home care for maintaining line patency and assessing the site.

3. At what point in the nurse-client relationship should termination first be addressed?

• A. in the working phase
• B. in the termination phase
• C. in the orientation phase
• D. when the client initially brings up the topic

Correct answer: C

Rationale: Termination in the nurse-client relationship should first be addressed in the orientation phase. This is because the client has a right to know the parameters of the relationship from the beginning. During the orientation phase, it is important to discuss if the relationship is time-limited, inform the client about the number of sessions, or explain that it is open-ended with the termination date to be negotiated later. Addressing termination in the orientation phase helps establish transparency and clear communication. Choices A, B, and D are incorrect because termination discussions should ideally start at the beginning of the relationship to set appropriate expectations.

4. The nurse assesses a client for physiological risk factors for falls. The nurse should conclude that the client is not at risk if which of the following is discovered?

• A. history of dizziness
• B. need for a wheelchair due to reduced mobility
• C. weakness and fatigue noted when climbing stairs
• D. intact recent and remote memory

Correct answer: D

Rationale: The correct answer is intact recent and remote memory. Intact memory function indicates that the client is less likely to be at risk for falls as it suggests cognitive awareness and orientation, which are important for safety. Choices A, B, and C are risk factors for falls: a history of dizziness can lead to imbalance, the need for a wheelchair due to reduced mobility can increase fall risk, and weakness and fatigue when climbing stairs indicate physical limitations that predispose a client to falls. Therefore, these options would suggest an increased risk for falls.

5. While on the wound care team, the nurse notices that a fellow nurse opens extra colloid dressings that are often thrown away when they are not needed. What should the nurse do?

• A. Do nothing, as it is not impacting client care.
• B. Discuss with the colleague the concern about wasting supplies.
• C. Tell the charge nurse to stop ordering these dressings.
• D. Remove the colloid dressings from the shelf so that the nurse will find other supplies to use.

Correct answer: B

Rationale: The correct answer is to discuss with the colleague the concern about wasting supplies. By addressing this issue, the nurse can promote cost-effective care within the unit. While it may not directly impact client care, the wastage of supplies affects the unit's supply cost, making choice A incorrect. Choice C is incorrect as it assumes the charge nurse is solely responsible for the ordering process and overlooks the opportunity for direct communication between colleagues. Choice D is incorrect as it involves taking matters into one's own hands rather than addressing the issue through communication and collaboration.

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