Nursing Elites

1. A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine?

• A. Tactile hallucinations
• B. Tardive dyskinesia
• C. Restlessness and muscle rigidity
• D. Reports of hearing disturbing voices

Correct answer: C

Rationale: Benztropine (Cogentin) is an anticholinergic medication used to treat extrapyramidal symptoms, such as restlessness and muscle rigidity, which are common side effects of antipsychotic medications like haloperidol. Tactile hallucinations and reports of hearing disturbing voices are symptoms of schizophrenia that would typically be addressed by the antipsychotic medication (haloperidol) itself. Tardive dyskinesia, a potential side effect of long-term antipsychotic use, would require discontinuation of the antipsychotic medication rather than administration of benztropine.

2. Which of the following is an example of a breach of a client's right to privacy?

• A. A nurse who is not caring for the client reads the client's personal information in the chart
• B. A client is not allowed to keep a copy of their original medical record
• C. A nurse files an incident report about a client that is reviewed with all staff at a meeting
• D. A client's photograph is used without permission for the hospital newsletter

Correct answer: D

Rationale: A breach of a client's right to privacy can occur when their personal information is used or disclosed without their consent. In this scenario, using a client's photograph without permission for the hospital newsletter violates their privacy rights. It is important to respect a client's confidentiality and seek their consent before using their personal information. Choices A, B, and C do not directly relate to breaching a client's right to privacy. Reading a client's personal information in their chart, not allowing a client to keep a copy of their medical record, and filing an incident report about a client do not necessarily violate their privacy rights as long as the information is handled appropriately and within legal and ethical boundaries.

3. Victor, a 43-year-old patient who is HIV positive with a diagnosis of pneumocystis carinii pneumonia (PCP), has been admitted to the hospital. His prognosis is very poor, and his partner, Roger, would like to have a ceremony performed in his room to honor their union in case something happens to Victor, who agrees. What is the most appropriate response to their request?

• A. Inform them that Victor is too ill for a ceremony
• B. Ask the social worker to intervene
• C. Tell them it's against hospital policy
• D. Coordinate with other disciplines to support their request

Correct answer: D

Rationale: The most appropriate and compassionate response is to respect Victor and Roger's relationship and honor their wishes. Coordinating with other disciplines, such as social work, chaplaincy, or patient advocacy, to support their request demonstrates a holistic approach to care. This collaborative effort can facilitate the ceremony and provide emotional support to both Victor and Roger during a challenging time. Upholding their request aligns with the principles of patient-centered care and promotes dignity and respect, as outlined in the ANA Code of Ethics. Informing them that Victor is too ill for a ceremony (Choice A) would dismiss their emotional needs and fail to address their request. Involving the social worker without understanding the specific request (Choice B) may not directly address their desire for a ceremony. Telling them it's against hospital policy (Choice C) disregards the importance of honoring patient preferences and may cause unnecessary distress in an already sensitive situation.

4. What might be signaled when a client tells the nurse to 'pray for me' and entrusts her wedding ring to the nurse?

• A. Anxiety
• B. Suicidal ideation
• C. Major depression
• D. Hopelessness

Correct answer: B

Rationale: The client entrusting the wedding ring and asking the nurse to pray for them can be indicative of suicidal ideation. This behavior suggests a deep level of distress and hopelessness, potentially leading to suicidal thoughts or actions. While anxiety is a common emotion, the act of entrusting personal items and making requests like praying for them go beyond typical anxiety symptoms. Major depression can be associated with suicidal ideation, but the specific actions described in this scenario point more towards suicidal thoughts. Hopelessness, while related to suicidal ideation, is a broader concept that does not capture the specific cues given by the client in this scenario, making it a less accurate choice.

5. Which of the following statements is true regarding non-profit organizations?

• A. They are located in various areas, not specifically poor or rural ones.
• B. They are mandated to care for people, even if clients are unable to pay for services.
• C. The money they receive for services is reinvested back into their own business to further develop services.
• D. They are not referred to as proprietary organizations.

Correct answer: B

Rationale: Non-profit organizations are entities that operate for a social cause or public benefit, and they do not distribute profits to owners or shareholders. They are not limited to being located in poor or rural areas; they can be found in various locations. One key characteristic of non-profits is that they are obligated to provide services, regardless of a client's ability to pay. This ensures that essential services are accessible to all individuals in need. The statement 'The money they receive for services is reinvested back into their own business to further develop services' is correct. Non-profit organizations reinvest any surplus funds back into their operations to enhance the services they provide. The statement 'They are not referred to as proprietary organizations' is correct because proprietary organizations are typically for-profit entities, not non-profit ones.

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