Nursing Elites

1. Which action exemplifies the use of evidence-based practice in the delivery of client care?

• A. Advising a client to agree to the treatment recommended by their healthcare provider
• B. Taking a rectal temperature from a client for whom bleeding precautions have been instituted
• C. Donning sterile gloves to change an abdominal wound dressing
• D. Encouraging a client to take an herbal substance to treat their insomnia

Correct answer: C

Rationale: Evidence-based practice is an approach to client care where the nurse integrates the client’s preferences, clinical expertise, and the best research evidence to deliver quality care. Donning sterile gloves to change an abdominal wound dressing exemplifies evidence-based practice as it prevents the entrance of harmful bacteria into the wound, following best practice guidelines. The other options do not align with evidence-based practice. Advising a client to agree to a treatment does not involve integrating research evidence. Taking herbal substances may not be supported by strong research evidence and can pose risks. Additionally, rectal temperature-taking in a client with bleeding precautions can increase the risk of injury to the rectal mucosa, not aligning with best practices in care delivery.

2. Following a recent tattoo, someone should be screened for:

• A. tuberculosis.
• B. herpes.
• C. hepatitis.
• D. syphilis.

Correct answer: hepatitis.

Rationale: Following a recent tattoo, someone should be screened for hepatitis. Tattooing puts a client at risk for blood-borne hepatitis B or C if strict sterile procedures are not followed. Tuberculosis is an airborne pathogen, while herpes and syphilis are spread through direct contact like sexual activity. Therefore, hepatitis is the most relevant infection to screen for after getting a tattoo.

3. A client admitted to the hospital has a do-not-resuscitate (DNR) order in his medical record. The nurse understands which information about DNR orders?

• A. The only individuals who may change the DNR order are healthcare providers
• B. The DNR order can be changed if the client's condition warrants it
• C. The DNR order does not remain fixed for the duration of the client's hospitalization
• D. The DNR order requires frequent review as specified by state or agency policy

Correct answer: The DNR order requires frequent review as specified by state or agency policy

Rationale: The correct answer is that the DNR order requires frequent review as specified by state or agency policy. If the client’s condition changes, the DNR order may need to be changed. For this reason, DNR orders require frequent review as specified by state or agency policy. A DNR order may be changed at any time and does not remain in effect for the duration of the client’s hospitalization. The client’s request regarding DNR status is the priority. Choice A is incorrect because healthcare providers, not just immediate family members, may change the DNR order based on the client's condition. Choice B is incorrect as DNR orders can be changed if the client's condition warrants it, not remaining unchanged. Choice C is incorrect as DNR orders are not fixed for the duration of hospitalization, they can be modified based on the client's needs.

4. When working with elderly clients, the healthcare provider should keep in mind that falls are most likely to happen to the elderly who are:

• A. in their 80s.
• B. living at home.
• C. hospitalized.
• D. living on only Social Security income.

Correct answer: hospitalized.

Rationale: The correct answer is 'hospitalized.' Elderly individuals are at a higher risk of falls, especially when they are in new environments like hospitals due to unfamiliarity with the surroundings, medications, and potential mobility challenges. Being in a hospital can disrupt their usual routines and increase the risk of falls. Choice A ('in their 80s') is not as directly related to the increased risk of falls in a hospital environment. Choice B ('living at home') is a common setting for the elderly but does not address the specific risk associated with being hospitalized. Choice D ('living on only Social Security income') is unrelated to the risk of falls based on the environment.

5. The nurse is working the same shift two days in a row. On the first of these days, while caring for one assigned client, the client says, “Will you promise me you will be my nurse tomorrow?” Which response is most appropriate?

• A. “Yes, I promise you I will be your nurse during my shift tomorrow.”
• B. “You will need to speak to my supervisor about this request.”
• C. “While I cannot promise that I will be your nurse tomorrow, I can talk to the charge nurse about this request.”
• D. “Because of confidentiality, I cannot discuss tomorrow’s assignments with you.”

Correct answer: “Because of confidentiality, I cannot discuss tomorrow’s assignments with you.”

Rationale: The most appropriate response is to maintain confidentiality regarding work assignments. It is crucial to uphold patient privacy and not disclose information about staff schedules or assignments. Choices A, B, and C involve promising or redirecting the patient, which is not suitable in this situation. Choice D respects confidentiality and is the most professional response in this scenario.

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