Nursing Elites

1. Victor, a 43-year-old patient who is HIV positive with a diagnosis of pneumocystis carinii pneumonia (PCP), has been admitted to the hospital. His prognosis is very poor, and his partner, Roger, would like to have a ceremony performed in his room to honor their union in case something happens to Victor, who agrees. What is the most appropriate response to their request?

• A. Inform them that Victor is too ill for a ceremony
• B. Ask the social worker to intervene
• C. Tell them it's against hospital policy
• D. Coordinate with other disciplines to support their request

Correct answer: D

Rationale: The most appropriate and compassionate response is to respect Victor and Roger's relationship and honor their wishes. Coordinating with other disciplines, such as social work, chaplaincy, or patient advocacy, to support their request demonstrates a holistic approach to care. This collaborative effort can facilitate the ceremony and provide emotional support to both Victor and Roger during a challenging time. Upholding their request aligns with the principles of patient-centered care and promotes dignity and respect, as outlined in the ANA Code of Ethics. Informing them that Victor is too ill for a ceremony (Choice A) would dismiss their emotional needs and fail to address their request. Involving the social worker without understanding the specific request (Choice B) may not directly address their desire for a ceremony. Telling them it's against hospital policy (Choice C) disregards the importance of honoring patient preferences and may cause unnecessary distress in an already sensitive situation.

2. Which is a physical, integumentary risk among the elderly population?

• A. Skin tears
• B. Thickened skin
• C. Thinning toe nails
• D. Less nasal hair

Correct answer: A

Rationale: Skin tears are a physical integumentary risk among the elderly population. As individuals age, their skin becomes thinner and more fragile, making them susceptible to skin tears. Thickened skin, thinning toenails, and reduced nasal hair are common age-related changes but do not pose the same level of risk as skin tears. Thickened skin may provide some protection, thinning toenails are primarily a cosmetic concern, and reduced nasal hair does not typically lead to significant health risks.

3. A client is seen in the emergency room as a victim of suspected domestic violence. The nurse's aide brings the client to a center curtained area, gives her a gown to change into, and asks her to wait for the nurse. What is the most appropriate action of the nurse upon arrival?

• A. Ask the client to undress to assess for injuries
• B. Take the client into a private room
• C. Notify the police to file a report
• D. Notify the house supervisor to keep security on alert

Correct answer: B

Rationale: When dealing with a client suspected of domestic violence, it is crucial to provide privacy and a safe environment. Taking the client into a private room allows for a confidential conversation and assessment without compromising the client's safety or dignity. The nurse should prioritize creating a safe space for the client to share information and receive support. Notification of authorities should only occur once a thorough assessment has been conducted to ensure the client's safety and well-being. Option A is incorrect because asking the client to undress should be done with sensitivity and respect for the client's privacy, focusing on assessing injuries rather than visualizing them. Option C is premature as involving the police should be based on a comprehensive assessment and the client's consent. Option D is not the most immediate and direct action required to address the client's immediate needs in a suspected domestic violence situation.

4. A client in the emergency room enters the care area to start an IV. He finds a man sitting on the table, hunched over, and attempting to take deep breaths. He states, 'my chest hurts so much!' His wife is sitting on a chair in the corner, crying. Which of the following is the first action of the client?

• A. Bring the IV kit and quickly start an IV
• B. Assess his breathing and provide oxygen, if necessary
• C. Administer medication to control chest pain
• D. Talk with his wife and find out why she is crying

Correct answer: B

Rationale: In the above scenario, the first action of the nurse should be to assess the client's airway and breathing. It is crucial to address respiratory status first, as the client appears to be experiencing difficulty breathing. Providing oxygen if necessary can help support oxygenation and alleviate potential respiratory distress. Administering medication for chest pain or starting an IV can come after ensuring adequate oxygenation. Talking with the client's wife, though important for emotional support, is not the priority when the client's respiratory status needs to be assessed and managed promptly.

5. You are caring for an infant who is just about 12 months old. Which assessment data is normal for the infant at this age?

• A. The infant had doubled their birth weight at twelve months.
• B. The infant had tripled their birth weight at twelve months.
• C. The mother reports that the infant is drinking 60 mLs per kilogram of its body weight.
• D. The infant had grown � inch since last month.

Correct answer: A

Rationale: The normal assessment data for the infant at 12 months of age is that the infant has doubled their birth weight at 12 months of age. The mother's reports that the infant is drinking 60 mLs per kilogram of its body weight and the fact that the infant had grown � inch since last month are not normal assessment data. Infants are fed breast milk or formula every two to four hours with a total daily intake of 80 to 100 mLs per kilogram of body weight. As the neonate grows, they gain five to seven ounces during the first six months and then they double their birth weight during the first year; the head circumference increases a half inch each month for six months and then two tenths of an inch until the infant is one year of age. Similarly, the height or length of the newborn increases an inch a month for the first 6 months and then 1/2 inch a month until the infant is 1 year of age.

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