Nursing Elites

1. The nurse is examining a 2-year-old child and asks, “May I listen to your heart now?” Which critique of the nurse’s technique is most accurate?

• A. Asking questions may enhance the child’s autonomy.
• B. Asking the child for permission helps develop a sense of trust.
• C. This question is an inappropriate statement because children at this age like to have choices.
• D. Children at this age like to say, “No.” The examiner should not offer a choice when no choice is available.

Correct answer: Children at this age like to say, “No.” The examiner should not offer a choice when no choice is available.

Rationale: Children at the age of 2 often like to assert their independence by saying “No.” In situations where there is actually no choice available, offering a false choice can lead to a lack of trust. It is important not to offer a choice when there isn't one, as doing so may undermine trust. While asking for permission can enhance autonomy and trust, offering a limited option like, “Shall I listen to your heart next or your tummy?” may be a better approach. Therefore, the correct critique of the nurse’s technique in this scenario is that children at this age tend to say “No,” so the examiner should avoid offering a choice when there isn't a real alternative.

2. While performing CPR, a healthcare provider encounters a client with a large amount of thick chest hair when preparing to use an automated external defibrillator (AED). What is the next appropriate action for the healthcare provider?

• A. Apply the pads to the chest and provide a shock
• B. Wipe the client's chest down with a towel before applying the pads
• C. Shave the client's chest to remove the hair
• D. Do not use the AED

Correct answer: Shave the client's chest to remove the hair

Rationale: When using an AED, it is crucial for the pads to have good contact with the skin to effectively deliver an electrical shock. While AED pads can adhere to a client's chest even with some hair, thick chest hair can hinder proper current conduction. In such cases, it is recommended to shave the area of the chest where the pads will be applied. Most AED kits include a razor for this purpose. The healthcare provider should act promptly to minimize delays in defibrillation. Option A is incorrect because it may lead to ineffective treatment due to poor pad adherence. Option B is not the best course of action as wiping the chest may not resolve the issue of poor pad contact. Option D is incorrect as not using the AED could jeopardize the client's chance of survival in a cardiac emergency.

3. When would chest thrusts be performed in an emergency situation?

• A. When performing CPR to initiate cardiovascular circulation.
• B. When assessing responsiveness of an unconscious patient.
• C. When assisting a pregnant woman who is choking.
• D. None of the above examples indicate the need for chest thrusts.

Correct answer: When assisting a pregnant woman who is choking.

Rationale: In the scenario of an emergency where a pregnant woman is choking, chest thrusts are performed to clear the airway obstruction. This technique is used instead of abdominal thrusts to avoid potential harm to the fetus. While chest thrusts are not as effective as abdominal thrusts in clearing obstructions, they are the preferred method in this specific situation. Choices A and B are incorrect as chest thrusts are not typically performed during CPR to initiate cardiovascular circulation or when assessing responsiveness of an unconscious patient. Choice D is incorrect as chest thrusts are indeed warranted when assisting a pregnant woman who is choking.

4. As a valued member of the team on your nursing care unit, you are trying to determine whether the team is doing well. Which of the following is a sign that your team is successful?

• A. Conflict occurs but is seen as an opportunity for team growth and development.
• B. No negative feelings are expressed, leading to everyone being happy and satisfied.
• C. Mistakes are not tolerated and result in disciplinary action.
• D. People avoid taking risks and stick to the status quo.

Correct answer: Conflict occurs but is seen as an opportunity for team growth and development.

Rationale: One of the key indicators of a successful team is the ability to handle conflict positively. Conflict, when managed well, can lead to team growth and development. Choice B is incorrect because suppressing negative feelings does not indicate team success; open communication is crucial. Choice C is incorrect as successful teams view mistakes as learning opportunities rather than resorting to disciplinary action. Choice D is incorrect because successful teams are often innovative and willing to take risks rather than maintaining the status quo.

5. According to the American Heart Association standards, high-quality CPR for an adult includes all of the following EXCEPT:

• A. Push hard
• B. Push fast
• C. Allow chest recoil between compressions
• D. Pause CPR as each drug is administered

Correct answer: Pause CPR as each drug is administered

Rationale: High-quality CPR for adults should not be paused for drug administration. The correct CPR technique involves pushing hard and fast, at a rate of at least 100 compressions per minute and to a depth of at least 2 inches. It is also essential to allow chest recoil between compressions to enable proper blood circulation. Pausing CPR for drug administration would delay the delivery of continuous chest compressions, which are crucial for maintaining blood flow and oxygenation during cardiac arrest.

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