Nursing Elites

1. Which of the following is an example of libel?

• A. A client overhears a nurse telling her assistant that he is 'too high maintenance.'
• B. A client reads disparaging remarks that a nurse has written about him in his chart.
• C. A nurse fails to notify a physician when a client's hemoglobin level is 8.1 gm/dL.
• D. A nurse administers narcotic pain medication to a client in pain but does not have an order.

Correct answer: B

Rationale: Libel involves making defamatory statements against another person in written form. These statements can harm the person's reputation or feelings. In this scenario, the correct answer is when a client reads disparaging remarks that a nurse has written about him in his chart. This constitutes libel because the negative remarks are written down and can potentially damage the client's reputation. Choices A, C, and D do not involve libel. Choice A describes a verbal statement, not written, so it does not constitute libel. Choice C involves a failure to notify a physician, which is a different issue unrelated to libel. Choice D pertains to administering medication without an order, which is a matter of improper practice rather than libel.

2. A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the healthcare provider ordering:

• A. Pulmonary embolectomy
• B. Vena caval interruption
• C. Increasing the coumadin therapy to achieve an INR of 3-4
• D. Thrombolytic therapy

Correct answer: B

Rationale: In the case of a client with a history of recurrent pulmonary embolism or contraindications to heparin, vena caval interruption may be necessary. Vena caval interruption involves placing a filter device in the inferior vena cava to prevent clots from traveling to the pulmonary circulation. Pulmonary embolectomy is a surgical procedure to remove a clot from the pulmonary artery, which is usually considered in severe or life-threatening cases. Increasing coumadin therapy to achieve a higher INR may be an option but vena caval interruption would be more appropriate in this scenario. Thrombolytic therapy is used in acute cases of pulmonary embolism to dissolve the clot rapidly, but in a recurrent case with contraindications to anticoagulants, vena caval interruption would be a preferred intervention.

3. A nurse is caring for a 3-day old infant who needs an exchange transfusion. Which of the following statements is appropriate for teaching the child's parents about this procedure?

• A. The registered nurse will be performing the procedure
• B. The procedure takes approximately 1 ? hours.
• C. The nurse will draw out 250cc of blood and then immediately replace it with 250cc
• D. The infant will continue to receive phototherapy during the procedure.

Correct answer: B

Rationale: : An exchange transfusion is a method of controlling high bilirubin levels in infants when traditional phototherapy is unsuccessful. During an exchange transfusion, the physician removes 5-10 cc of blood and then replaces it with donor blood. The parents of this infant should know that the procedure is always performed by a physician and will take approximately 1 � hours to complete.

4. Plantar flexion can be prevented with ________________.

• A. foot soaks
• B. foot boards
• C. toenail care
• D. proper shoes

Correct answer: B

Rationale: Plantar flexion, or foot drop, can be prevented with foot boards, special splints, and range of motion exercises. Foot boards help maintain the foot in a neutral position, preventing contractures and deformities. Foot soaks (choice A) may help with foot hygiene but do not directly prevent plantar flexion. Toenail care (choice C) is important for overall foot health but does not prevent plantar flexion. Proper shoes (choice D) are essential for foot support and comfort but do not specifically prevent plantar flexion.

5. Which of the following interventions should be prioritized in the care of the suicidal client?

• A. Remove all potentially harmful items from the client's room
• B. Allow the client to express feelings of hopelessness
• C. Note the client's capabilities to increase self esteem
• D. Set a "no suicide"? contract with the client

Correct answer: A

Rationale: accessibility of the means of suicide increases the lethality. Allowing a patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients but not specifically for suicide.

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