Nursing Elites

1. In which of the following situations would the use of physical restraints most likely be justified?

• A. Mr. Y is agitated and aggressive while experiencing severe alcohol withdrawal and is not responding to chemical sedation.
• B. Mrs. U, diagnosed with dementia, was found wandering outside the hospital, and nurses have been unable to redirect her to stay on the unit.
• C. Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously.
• D. Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds.

Correct answer: A

Rationale: Answer A is the correct choice because it describes a situation where the client poses a risk due to agitation and aggression during severe alcohol withdrawal, and chemical sedation has not been effective. In such cases, physical restraints may be justified as a last resort to ensure the safety of the client and others. Choices B, C, and D present scenarios where alternative strategies like redirection, addressing delirium, or implementing behavioral interventions should be attempted before considering physical restraints.

2. A nurse manager works in a setting where projections for the future include a more diverse ethnic mix of older adults. Which action will the nurse manager take?

• A. Recruit multilingual nurses.
• B. Request volunteers for the ethics committee.
• C. Develop nurses' cultural competence.
• D. Teach nurses about a variety of religious practices.

Correct answer: C

Rationale: Nurses working in a setting with a diverse ethnic mix will need to exhibit cultural competence. Thus, the nurse manager should work to develop cultural competence in nursing staff. Developing nurses' cultural competence involves understanding and respecting the beliefs, values, and practices of different cultural groups, which is essential for providing effective care. Recruiting multilingual nurses could be beneficial, but cultural competence goes beyond language skills to encompass a deeper understanding of cultural nuances. Teaching nurses about a variety of religious practices is important for a holistic approach to care, but focusing solely on religious practices may not fully address the diverse cultural needs of older adults. Ethical dilemmas may not be directly related to the projected increase in diversity, so requesting volunteers for the ethics committee does not directly address the need for cultural competence in caring for a more diverse ethnic mix of older adults.

3. An older adult client tells the nurse that blockage of qi in one of the body's meridians is causing severe headaches. The health care provider has diagnosed migraines and has prescribed a triptan drug. Which action would be most appropriate for the nurse to implement?

• A. Suggest that the prescribed medicine may stimulate the flow of qi
• B. Explain the vasoconstrictive and serotonin-moderating action of triptan
• C. Instruct the client to take as many doses as needed for relief
• D. Caution the client that the headaches will grow worse if the client fails to take the medication

Correct answer: A

Rationale: Qi is the life force that circulates through the body in invisible pathways called meridians. In this scenario, the client believes that the blockage of qi is causing severe headaches. While explaining the scientific principles underlying the drug action could be valuable, it's crucial to consider the client's belief system. Therefore, the most appropriate response is to suggest that the prescribed medicine may stimulate the flow of qi, aligning with the client's perspective. Choice B, explaining the vasoconstrictive and serotonin-moderating action of triptan, does not address the client's concerns about qi blockage. Choice C, instructing the client to take as many doses as needed, can lead to potential medication misuse. Choice D, cautioning the client about worsening headaches without medication, may induce fear and hinder effective communication with the client.

4. How might the nursing home's social worker help Ms. O's friends in visiting her?

• A. The social worker should defer to the nursing staff
• B. Help her friends find easier transportation
• C. Tell her to make friends at the dialysis center
• D. Ask other residents' families to bring her friends with them

Correct answer: B

Rationale: The correct answer is B. Ms. O's friends, who are elderly and cannot drive, ride buses to visit her. The social worker can help by finding easier transportation options for them. Not having family around, friends' visits can significantly impact Ms. O's well-being. It may be challenging for the friends to ask for help themselves, so the social worker can reach out to volunteer groups for assistance. Making friends at the dialysis center might not be feasible due to the nature of treatments. Asking other residents' families to bring her friends could burden them further and might deter them from helping. It's important to consider the friends' convenience and emotional support for Ms. O.

5. A nurse is performing a health history on a client who identifies as Native American/First Nations. Based on familial history and racial disparities, for which health issue should the nurse prepare to monitor in this client?

• A. autoimmune disorders
• B. heart disease
• C. Alzheimer's disease
• D. lung cancer

Correct answer: B

Rationale: The correct answer is B: heart disease. Heart disease is a major health issue among Native American/First Nations populations, along with diabetes, malignant neoplasm, and unintentional injuries, contributing to a decreased lifespan. Autoimmune disorders, Alzheimer's disease, and lung cancer are not the primary health concerns that the nurse should monitor for in this client. By understanding the prevalent health issues in this population, the nurse can provide targeted care and interventions to promote better health outcomes.

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