Nursing Elites

1. What information does the healthcare provider remember regarding do-not-resuscitate (DNR) orders in this scenario?

• A. That a DNR order may be written by a healthcare provider
• B. That everything possible must be done if the client stops breathing
• C. That medications only may be given to the client if the client stops breathing
• D. That life support measures will have to be implemented if the client stops breathing

Correct answer: A

Rationale: In a situation where a client has no family members and the client's wife is mentally incompetent, the healthcare provider may write a DNR order if it is deemed medically certain that resuscitation would be futile. A DNR order is a medical directive that instructs healthcare providers not to perform CPR if a patient's heart stops or if the patient stops breathing. Option A is correct because a DNR order can indeed be issued by a healthcare provider under certain circumstances, as it is a medical decision. Options B, C, and D are incorrect as they do not accurately reflect the concept of DNR orders and the decision-making process involved in such situations.

2. Which of the following nursing diagnoses is most appropriate for a client with a new colostomy?

• A. Excess Fluid Volume
• B. Risk for Aspiration
• C. Disturbed Body Image
• D. Urinary Retention

Correct answer: C

Rationale: Disturbed Body Image is the most appropriate nursing diagnosis for a client with a new colostomy. A new colostomy can significantly impact a person's body image and self-esteem due to the physical changes it brings. This can lead to emotional distress, adjustment issues, and concerns about body image. Excess Fluid Volume, Risk for Aspiration, and Urinary Retention are not directly related to the psychosocial impact of a new colostomy and are therefore not as relevant in this context. While Excess Fluid Volume, Risk for Aspiration, and Urinary Retention are important nursing diagnoses, they are not the priority when considering the psychological and emotional effects of a new colostomy.

3. In a centralized decision-making process within an organization, where is the authority to make decisions vested?

• A. Every employee
• B. A few individuals, such as the board of directors
• C. Many individuals, with decisions filtering down to the individual employee
• D. All nursing employees, pharmacists, and hospital health care providers

Correct answer: B

Rationale: In a centralized decision-making process within an organization, the authority to make decisions is concentrated in a few individuals, such as the board of directors. This means that key decision-making power is held by a select group at the top of the organizational hierarchy. Choices A, C, and D are incorrect because in a centralized structure, decision-making authority is not distributed among every employee, does not filter down to individual employees, and is not shared among all nursing employees, pharmacists, or hospital health care providers. Centralized decision-making implies a more top-down approach.

4. In which situation is the nurse upholding the ethical principle of fidelity?

• A. Providing complete information regarding treatment options to a client with newly diagnosed cancer
• B. Allowing a client to decide when to receive daily hygiene care
• C. Inserting a 19-gauge intravenous catheter into a client requiring a blood transfusion
• D. Contacting the health care provider about the client's request to incorporate complementary therapies for pain into the treatment plan

Correct answer: D

Rationale: Fidelity is the ethical principle of keeping promises made to clients, families, and other healthcare professionals. Contacting the health care provider about the client's request to incorporate complementary therapies for pain into the treatment plan exemplifies fidelity. By advocating for the client's preferences and ensuring their requests are addressed, the nurse demonstrates a commitment to fulfilling promises made to the client. Allowing a client to decide when to receive daily hygiene care relates to respecting autonomy, not fidelity. Inserting a 19-gauge intravenous catheter into a client needing a blood transfusion aligns with beneficence, as it involves taking action to provide necessary treatment. Providing complete information to a client with newly diagnosed cancer about treatment options reflects justice, promoting fairness and equity in healthcare by offering equal access to information and treatment choices.

5. A nurse is planning task assignments for the day. Which assignment is the least appropriate for the nursing assistant?

• A. Assisting a client with dysphagia in eating
• B. Ambulating a client with Parkinson's disease
• C. Providing hygiene to a client with dementia
• D. Assisting a client with an above-the-knee amputation in showering

Correct answer: A

Rationale: The least appropriate assignment for a nursing assistant would be assisting a client with dysphagia in eating. This task requires specialized skills and knowledge to prevent complications such as choking and aspiration. Ambulating a client with Parkinson's disease, providing hygiene to a client with dementia, and assisting a client with an above-the-knee amputation in showering are tasks that a nursing assistant can safely perform without significant risk of complications. Assisting a client with dysphagia in eating involves higher risks and requires specific training, making it the least appropriate choice for a nursing assistant.

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