Nursing Elites

1. When teaching a client with coronary artery disease about nutrition, what should the nurse emphasize?

• A. Eating three balanced meals a day
• B. Adding complex carbohydrates
• C. Avoiding very heavy meals
• D. Limiting sodium intake to 7 g per day

Correct answer: C

Rationale: The correct answer is to emphasize avoiding very heavy meals. Eating large, heavy meals can divert blood away from the heart for digestion, potentially endangering clients with coronary artery disease. This practice may lead to an increased risk of plaque accumulation in the arteries, potentially obstructing the delivery of blood and oxygen to vital organs. Choices A, B, and D are incorrect. While eating three balanced meals a day, adding complex carbohydrates, and limiting sodium intake are generally good dietary practices, they are not the primary focus when teaching a client with coronary artery disease about nutrition. The emphasis should be on avoiding heavy meals that can strain the cardiovascular system.

2. After a lengthy explanation of a medical procedure, the patient asks many questions. The physician answers all of the questions to the best of their ability. The patient then gives consent for treatment. The costly equipment and supplies are put into place, and the patient is prepared. Two minutes before the procedure is to start, the patient begins panicking and changes their mind. Which of the following situations would be the best way to avoid litigation?

• A. Document that the patient originally gave consent and proceed if the benefits of the procedure outweigh the patient's wishes.
• B. Have the patient sign a form stating that they are refusing consent. If they refuse to sign, do not proceed with the procedure.
• C. Repeat the explanation of the procedure until the patient understands that having the procedure done is the best form of treatment. Do not proceed with the procedure.
• D. Do not proceed. Document the patient's refusal, have the patient sign a refusal to consent to treatment. If the patient refuses to sign the form, have a witness available to sign.

Correct answer: D

Rationale: In this scenario, the best course of action to avoid litigation is to respect the patient's right to refuse treatment, especially when changing their mind before the procedure starts. By not proceeding with the treatment, documenting the patient's refusal, and having the patient sign a refusal to consent form, you are following proper ethical and legal procedures. If the patient refuses to sign the form, having a witness available to sign further strengthens the documentation of the patient's decision. This approach ensures that the patient's autonomy and right to make informed decisions about their healthcare are respected. Choices A, B, and C do not prioritize the patient's right to refuse treatment and could potentially lead to legal issues if treatment is carried out against the patient's wishes.

3. A nurse is assigned to care for a deaf client. During her lunch hour, she visits the hospital library and reads more about deaf culture in order to better provide appropriate care for her client. This action is an example of:

• A. Cultural knowledge
• B. Cultural noise
• C. Cultural diversity
• D. Cultural divide

Correct answer: A

Rationale: Cultural knowledge involves seeking information and educating oneself about different cultural groups. In this scenario, the nurse is demonstrating cultural knowledge by learning more about deaf culture to improve the care provided to the deaf client. This proactive approach helps in understanding the client's background, beliefs, and communication preferences, leading to better outcomes. 'Cultural noise' and 'Cultural divide' are incorrect as they do not reflect the nurse's positive action of seeking knowledge to enhance care. 'Cultural diversity' is also incorrect as it does not accurately describe the nurse's specific action of acquiring knowledge about a particular culture.

4. Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse?

• A. Standard four-drug therapy for TB
• B. Need for annual repeat TB skin testing
• C. Use and side effects of isoniazid (INH)
• D. Bacille Calmette-Gurin (BCG) vaccine

Correct answer: C

Rationale: The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States for TB and would not be helpful for this individual, who already has a TB infection.

5. A writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially, the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign a staff member to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is demanding, arrogant, talks fast, and is hyperactive, setting realistic limits to the client's behavior is essential to ensure safety as manic clients may engage in injurious activities. A quiet environment and consistent, firm limits help to maintain control. While repeating verbal instructions may be necessary due to distractibility, it is not the priority compared to setting limits for safety. Allowing the client to express feelings is important, but only non-destructive methods of expression should be permitted. Assigning a staff member to be with the client at all times is not a realistic approach as it may not always be feasible or necessary for managing manic behavior effectively.

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