Nursing Elites

1. When a 17-year-old client arrives at the clinic suspecting a sexually transmitted infection, what information does the nurse provide concerning informed consent?

• A. She will need to sign an informed consent form.
• B. Her mother or father will need to be contacted for permission to treat her.
• C. A consent form is not needed if the problem is a sexually transmitted infection.
• D. Anyone over the age of 18 years may sign a consent form for her treatment.

Correct answer: A

Rationale: Informed consent is a person's agreement to allow something, such as a treatment, to be performed. A consent form is required even if the problem is a sexually transmitted infection. If the client is a minor, the minor may sign the informed consent form in specific situations, including seeking treatment for a sexually transmitted infection. In this case, the 17-year-old client is seeking examination and treatment for a sexually transmitted infection, so she will need to sign the informed consent form. Contacting her parents for permission is not required in this situation. Choice C is incorrect because a consent form is necessary regardless of the medical issue. Choice D is incorrect because the individual's age is not the determining factor; rather, it is the nature of the medical service being sought that dictates the need for informed consent.

2. A nurse manager asks a nurse to work overtime because of a short-staffing problem. The nurse has made plans to do Christmas shopping after work and does not want to work overtime. What is the most assertive response by the nurse to her nurse manager?

• A. "I'm not working overtime today."
• B. "I have plans after work and will not be able to work overtime."
• C. "You know how I hate to work overtime."
• D. "I will if you need me, but I am not happy about this."

Correct answer: B

Rationale: The most assertive response in dealing with this conflict is the one that is direct and conveys a clear message in a positive manner. The nurse should assertively communicate her unavailability for overtime without being confrontational. Option A, "I'm not working overtime today," is too blunt and may come across as rude. Option C, "You know how I hate to work overtime," is not assertive but rather passive-aggressive. Option D, "I will if you need me, but I am not happy about this," is a passive-aggressive response as it implies compliance while expressing discontent. Option B, "I have plans after work and will not be able to work overtime," is the most appropriate response as it clearly states the nurse's unavailability without unnecessary aggression.

3. While taking care of a client, the nurse thinks that physical therapy in the hospital might be beneficial to their condition. The following is the ideal referral process EXCEPT?

• A. Transport the client to the physical therapy room for treatment after receiving an official referral.
• B. Provide the physical therapist with the client's medical record after the referral.
• C. Contact the client's primary care provider to suggest a physical therapy referral.
• D. Request the client to self-refer to the physical therapist.

Correct answer: D

Rationale: The ideal referral process for a client to receive physical therapy in the hospital starts with the nurse contacting the client's primary care provider to discuss and suggest a physical therapy referral. The primary care provider should provide an official referral, which is crucial for initiating the treatment process. After obtaining the official referral, the nurse should provide the physical therapist with the client's medical record. This step is essential for the therapist to assess the client's condition and customize the treatment plan accordingly. Once the physical therapist is informed and prepared, the nurse can then transport the client to the physical therapy room for treatment. Therefore, the correct sequence is to first contact the primary care provider (Choice C), then provide the medical record (Choice B), and finally transport the client for treatment (Choice A). Choice D, suggesting the client self-refer to the physical therapist, is incorrect as the referral process should involve healthcare professionals to ensure proper assessment and treatment planning.

4. A nurse discharge planner is preparing a client for discharge from an acute care setting. The nurse assesses that skilled home care services are clinically indicated. This assessment is based on all of the following indicators except:

• A. the client has been admitted to the hospital three times in the last 2 months.
• B. the client has a Foley catheter.
• C. the client's family is available to care for him 24 hours a day.
• D. the client is ordered to continue IV antibiotics 5 days post discharge.

Correct answer: V

Rationale: Family availability to provide care and assistance is not an indicator for skilled home care services. In fact, the nurse might see an opportunity for family education to meet the client's needs so that less community support is needed. This should be discussed and negotiated with the family. Frequent hospital readmissions indicate that the client has not been able to manage either due to condition instability or lack of care needs being met, which is a red flag for home care services to monitor and meet those needs appropriately. A Foley catheter requires home health care due to infection potential and care requirements. IV antibiotics also necessitate home care for maintaining line patency and assessing the site.

5. Which of the following might be an appropriate nursing diagnosis for an epileptic client?

• A. Dysreflexia
• B. Risk for Injury
• C. Urinary Retention
• D. Unbalanced Nutrition

Correct answer: B

Rationale: The correct nursing diagnosis for an epileptic client would be 'Risk for Injury' as the client is prone to injuries during seizure activity, such as head trauma from falls. Epilepsy does not typically cause dysreflexia. While urinary retention may occur during or after a seizure, it is not a common nursing diagnosis related to epilepsy. 'Unbalanced Nutrition' is not a priority nursing diagnosis for an epileptic client compared to the immediate risk of injury during seizures.

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