Nursing Elites

1. 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.

2. 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.

3. During a health history assessment of a new patient, which data should be the focus for patient teaching?

• A. Age and gender
• B. Saturated fat intake
• C. Hispanic/Latino ethnicity
• D. Family history of diabetes

Correct answer: B

Rationale: The correct answer is saturated fat intake. Behaviors play a crucial role in health outcomes, and saturated fat intake is a modifiable behavior that can significantly impact a patient's health. By focusing on educating the patient about reducing saturated fat intake, the healthcare provider can empower the patient to make positive changes. While age, gender, ethnicity, and family history are important factors in understanding a patient's health status, they are not behaviors that can be directly modified through patient teaching. Therefore, these factors are essential for developing an individualized care plan but are not the primary focus of patient teaching. Saturated fat intake directly relates to dietary habits, which can be altered through education and support to promote better health outcomes.

4. A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical exam?

• A. Start the hepatitis B immunization series.
• B. Teach the patient about hepatitis A immune globulin.
• C. Ask whether the patient has been screened for hepatitis C.
• D. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).

Correct answer: C

Rationale: The correct action for the nurse to include in care when the patient is seen for a routine annual physical exam, according to CDC guidelines, is to ask whether the patient has been screened for hepatitis C. CDC guidelines recommend screening patients born between 1945 and 1965 for hepatitis C due to the high prevalence of undiagnosed cases in this age group. Starting the hepatitis B immunization series is not necessary as the patient already had hepatitis A infection. Teaching the patient about hepatitis A immune globulin is not indicated in this scenario. Testing for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM) is not needed as the patient has already had hepatitis A.

5. Which of the following may be a cultural barrier that impacts a healthcare provider's ability to provide care or education to the client?

• A. A healthcare provider offers educational materials to a client that are written at an 8th-grade reading level
• B. A Vietnamese woman wants to use steaming in addition to her prescription antibiotics
• C. A healthcare provider uses pantomime to explain a procedure to a deaf client
• D. A Native American client requests a healing ritual before considering surgery

Correct answer: C

Rationale: Cultural barriers can impede communication, hindering a healthcare provider's ability to provide education or instructions about a client's care. In the context of cultural sensitivity, using pantomime to explain a procedure to a deaf client can be ineffective and inappropriate. This approach implies a lack of recognition of the importance of proper communication methods, such as sign language interpreters, which are crucial for effective communication with individuals who are deaf. Miscommunication is likely to occur if the client does not understand the gestures and actions of the healthcare provider. This scenario highlights the significance of understanding and respecting different cultural practices and communication needs to deliver optimal care and education. Choice A is incorrect because offering educational materials at an appropriate reading level demonstrates consideration for the client's literacy level, which can enhance understanding and compliance with medical instructions. Choice B is incorrect as incorporating a client's cultural practices, such as steaming, alongside prescribed treatments can be a part of culturally competent care. Choice D is incorrect as respecting a client's request for a healing ritual aligns with providing patient-centered care that acknowledges and integrates cultural beliefs and preferences.

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