Nursing Elites

1. Mr. K is admitted to the orthopedic unit one morning in preparation for a total knee replacement to start in two hours. Which of the following is a priority topic to instruct this client on admission?

• A. The approximate length of the surgery
• B. The type of anticoagulants that will be prescribed
• C. The time of the next meal of solid food
• D. The length of time until the client can return to work

Correct answer: A

Rationale: The priority topic to instruct a client admitted for a total knee replacement surgery should be the approximate length of the surgery. Pre-surgical teaching should focus on preparing the client for the upcoming procedure. Providing information about the duration of the surgery can help manage the client's expectations, reduce anxiety, and ensure they are mentally prepared for the operation. While details about post-operative care, anticoagulants, meals, and return to work are important, they are not the immediate priority during the preoperative phase. These aspects can be addressed at a later stage in the client's care journey.

2. A patient in the cardiac unit is concerned about the risk factors associated with atherosclerosis. Which of the following are hereditary risk factors for developing atherosclerosis?

• A. Family history of heart disease
• B. Overweight
• C. Smoking
• D. Age

Correct answer: A

Rationale: A family history of heart disease is an inherited risk factor for developing atherosclerosis. This factor is not modifiable through lifestyle changes. Studies have shown that having a first-degree relative with heart disease significantly increases the individual's risk of developing atherosclerosis. Overweight, smoking, and age are not hereditary risk factors for atherosclerosis. Overweight and smoking are lifestyle-related risk factors, while age is a non-modifiable risk factor that increases with time but is not directly inherited.

3. You are on the unit and overhear another nurse talking on the phone to a patient's friend who wants to see her patient who is comatose and on a ventilator. Since you cared for that patient yesterday, you know that the patient's significant other, who is also the designated healthcare surrogate (HCS) and has power of attorney (POA), has expressly stated that he wants this person on the list for restricted visitors. The nurse whispers that she'll call him to visit as soon as the significant other has gone home. What should your first response be?

• A. Inform the significant other
• B. Report the nurse to the nurse manager
• C. Speak with the nurse directly in private
• D. Call the visitor and tell him he can't visit

Correct answer: C

Rationale: Speaking with the nurse directly and privately is the most constructive manner in which to handle this situation and advocate for the significant other's wishes. Doing so will open communication with a peer and build the relationship, instead of alienating the other nurse by taking action that does not involve her and will cast her in a negative light with others. It is essential to express your concerns regarding honoring the significant other's requests and rights regarding the limitation of visitors. Option A is incorrect because the significant other is not the one trying to visit, and it is more appropriate to address the nurse directly first. Option B is not the best initial response as it may escalate the situation without giving the nurse a chance to correct the issue. Option D is incorrect as it does not address the issue at its source and may create further conflict without resolving the underlying problem.

4. Which of the following interventions should be prioritized in the care of the suicidal client?

• A. Remove all potentially harmful items from the client's room
• B. Allow the client to express feelings of hopelessness
• C. Note the client's capabilities to increase self esteem
• D. Set a "no suicide"? contract with the client

Correct answer: A

Rationale: accessibility of the means of suicide increases the lethality. Allowing a patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients but not specifically for suicide.

5. In which of the following examples would informed consent not be required?

• A. A patient is apprehensive about an upcoming surgery and chooses not to learn of the risks involved with the procedure.
• B. A child is rushed to the Emergency Room after falling from a third-story window.
• C. An adult in a coma in a mental health institution with no listed next of kin.
• D. Informed consent is not required in any of the above examples.

Correct answer: D

Rationale: In emergency situations where immediate treatment is necessary to prevent further harm or save a life, such as in option B where a child is rushed to the Emergency Room after a fall, informed consent may be waived to provide prompt care. In option A, though the patient is apprehensive about surgery and chooses not to learn the risks, informed consent is not required as it is the patient's right to refuse information. In option C, when an adult is in a coma with no next of kin listed, decisions may be made in the patient's best interest following legal and ethical guidelines. Therefore, informed consent is not needed in any of the scenarios presented.

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