Nursing Elites

1. The client is unsure about making medical decisions as their disease progresses and wants to appoint someone to make these decisions. Which of the following options would be most appropriate?

• A. a living will
• B. informed consent
• C. a healthcare proxy
• D. non-informed consent

Correct answer: C

Rationale: The correct answer is 'a healthcare proxy.' A healthcare proxy involves the client appointing an individual to make medical decisions on their behalf if they become unable to do so. This option allows the client to choose someone they trust to act in their best interests. Choice A, 'a living will,' is a legal document that outlines a person's wishes regarding medical treatment in case they are unable to communicate their decisions. While it is important, it does not involve appointing someone to make decisions. Choice B, 'informed consent,' is a process where a healthcare provider explains a treatment or procedure, including its risks and benefits, to a patient who can then decide whether to proceed. This is not about appointing someone to make decisions on the patient's behalf. Choice D, 'non-informed consent,' is not a valid concept in healthcare. Informed consent is crucial for respecting a patient's autonomy and decision-making capacity.

2. A health care provider writes a medication prescription in a client's record. While transcribing the prescription, the nurse notes that the prescribed dose is three times higher than the recommended dose. The nurse calls the health care provider, who states that this is the dose that the client takes at home and that it is acceptable for this client's condition. What is the appropriate action for the nurse to take?

• A. Verifying the prescribed dose with the client before administering the medication
• B. Contacting the nursing supervisor
• C. Asking the nurse assigned to care for the client to administer the medication
• D. Continuing to transcribe the prescription

Correct answer: B

Rationale: In this scenario, the nurse has identified a significant discrepancy between the prescribed dose and the recommended dose. While the health care provider has justified the higher dose based on the client's home regimen, the nurse's primary responsibility is to ensure patient safety. If a nurse has concerns about a prescription being incorrect or potentially harmful, they should seek further clarification from the health care provider. Since the nurse still believes the dose is inappropriate after discussing with the health care provider, the next appropriate action is to contact the nursing supervisor. Continuing to transcribe the prescription without addressing the concern could jeopardize the client's safety. Asking another nurse to administer the medication without proper resolution of the dosage concern would also pose a risk to the client. While verifying the prescribed dose with the client is important, in this situation, the nurse should first escalate the issue to the nursing supervisor to ensure appropriate actions are taken.

3. A nurse is preparing to administer medications to a client via a nasogastric (NG) tube. Before administering the medication, the nurse must first take which action?

• A. Check the client's apical pulse
• B. Check when the last feeding was given
• C. Check the placement of the tube
• D. Check when the last medications were given

Correct answer: C

Rationale: Before administering medications through an NG tube, the nurse must first check the placement of the tube to prevent aspiration. This is done by aspirating gastric contents and measuring the pH. Checking the client's apical pulse is unrelated to NG tube medication administration. Checking when the last feeding was given is important but not a priority before administering medications. Checking when the last medications were given is also not directly related to ensuring the safe administration of medications through an NG tube. Ensuring the correct placement of the tube is crucial to prevent complications such as pulmonary aspiration.

4. Which of these statements from the caregiver of a palliative care client indicates a proper understanding?

• A. This treatment plan usually indicates a prognosis of less than 6 months.
• B. We will need to stay in the hospital to receive this level of care.
• C. The main therapeutic goals are comfort and better quality of life.
• D. The medications to treat the underlying disease will be continued.

Correct answer: C

Rationale: The correct answer is 'The main therapeutic goals are comfort and better quality of life.' This statement reflects a proper understanding of palliative care, which focuses on improving the patient's quality of life and providing comfort. It does not necessarily mean a prognosis of less than 6 months or require hospitalization. Choice A is incorrect because palliative care can be provided regardless of the prognosis. Choice B is wrong as palliative care can be administered in various settings, not just hospitals. Choice D is inaccurate as palliative care aims to improve symptoms and quality of life, so medications may be adjusted but not necessarily stopped.

5. Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be

• A. Outbreak of Asian flu.
• B. Chemical exposure.
• C. Bacterial pneumonia.
• D. Allergic reaction.

Correct answer: B

Rationale: In the scenario described, where multiple passengers on an airliner experience sudden weakness and breathing difficulty simultaneously, the most likely cause is chemical exposure. This is because a sudden onset of similar symptoms in a group of individuals suggests a common environmental factor affecting them. Options A, C, and D are less likely as they do not explain a sudden onset of symptoms in multiple individuals simultaneously. Asian flu (Option A) is a viral infection and would not typically result in sudden symptoms in multiple individuals at the same time. Bacterial pneumonia (Option C) is a localized infection and not a probable cause for a sudden onset of symptoms in a group. An allergic reaction (Option D) would usually occur in individuals with specific allergies rather than affecting a group of passengers at the same time.

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