Nursing Elites

1. The nurse is caring for a client awaiting test results on a biopsy. The client is unconscious, and the physician informs the client's spouse that the biopsy came back positive for cancer. The spouse asks the nurse if they will not share this news with the client because they would prefer the client be unaware of the diagnosis. Which of the following responses is most appropriate?

• A. "I will have a psychiatrist confirm whether the news will cause negative effects, and if so, I will comply with your request."?
• B. "For ethical reasons, I am unable to withhold this information from the client."?
• C. "You do not have the option to sign paperwork stating you are accepting the risk of not sharing this with the client."?
• D. "You must have a durable power of attorney for healthcare advanced directive in place before I can consider this request."?

Correct answer: B

Rationale: The correct response is, "For ethical reasons, I am unable to withhold this information from the client."? The ethical principle of veracity requires that the nurse is truthful with the client and does not withhold information even if it is requested by the family. Choice A is incorrect because seeking a psychiatrist's confirmation is not necessary to uphold the ethical principle of truth-telling. Choice C is incorrect as implying that signing paperwork overrides the nurse's ethical obligation to be honest with the client is inappropriate. Choice D is also incorrect as a durable power of attorney is not relevant in this situation where the spouse is asking the nurse to withhold information.

2. Which type of diet should the nurse provide to help a client who has major burns maintain a positive nitrogen balance?

• A. high protein
• B. high carbohydrate
• C. low carbohydrate
• D. low protein

Correct answer: A

Rationale: Clients with major burns are in a hypermetabolic state, leading to increased protein catabolism. Therefore, a high-protein diet is essential to help them maintain a positive nitrogen balance and support wound healing. High carbohydrate diets do not directly contribute to achieving a positive nitrogen balance, making choice B incorrect. Similarly, low carbohydrate diets are not recommended for clients with major burns as carbohydrates provide essential energy needed for healing. Low protein diets are contraindicated for clients with major burns as they require higher protein intake to support tissue repair and prevent further breakdown.

3. Which cultural group has the highest incidence of inflammatory bowel disease (IBD)?

• A. Asians
• B. Caucasians
• C. Hispanics
• D. African Americans

Correct answer: B

Rationale: The correct answer is Caucasians. Studies have shown that Caucasians have the highest incidence of inflammatory bowel disease (IBD) compared to other cultural groups. While IBD can affect individuals from various backgrounds, the prevalence is notably higher in Caucasians. Asians, Hispanics, and African Americans have a lower incidence of IBD compared to Caucasians, making them incorrect choices in this context.

4. Nurses caring for clients who have cancer and are taking opioids need to assess for all of the following except:

• A. tolerance.
• B. constipation.
• C. sedation.
• D. addiction.

Correct answer: D

Rationale: When caring for clients with cancer who are taking opioids, nurses need to assess for tolerance, constipation, and sedation as these are common side effects of opioid use. Addiction, however, is not a primary concern when treating pain in terminally ill clients. Terminally ill patients are usually not at risk of developing addiction to opioids due to their short life expectancy and the focus on pain management rather than the potential for addiction. Therefore, the correct answer is 'addiction.' Choices A, B, and C are essential considerations when managing clients on opioids for pain control.

5. Which is the correct order regarding the hierarchy of members of the nursing team from least authority to highest authority?

• A. LPN, staff nurse, charge nurse, nurse manager
• B. Staff nurse, LPN, nurse manager, charge nurse
• C. LPN, staff nurse, charge nurse, nurse manager
• D. LPN, staff nurse, charge nurse, nurse manager

Correct answer: C

Rationale: The correct hierarchy order from least to highest authority in the nursing team is LPN (Licensed Practical Nurse), staff nurse, charge nurse, and nurse manager. LPNs have the least authority, followed by staff nurses who are supervised by charge nurses. Nurse managers oversee the charge nurses, making them the highest authority in this hierarchy. Therefore, choices A, B, and D are incorrect as they do not follow the correct order of authority within the nursing team.

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