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. Quality is defined as a combination of all of the following except:

• A. conforming to standards.
• B. performing at the minimally acceptable level.
• C. meeting or exceeding customer requirements.
• D. exceeding customer expectations.

Correct answer: B

Rationale: Quality in any context is about meeting or exceeding customer requirements and exceeding customer expectations. It also involves conforming to standards to ensure consistency and reliability. Merely performing at the minimally acceptable level does not encompass the essence of quality, as it sets the bar at the lowest level of acceptability rather than aiming for excellence or customer satisfaction. Therefore, the correct answer is 'performing at the minimally acceptable level,' as this choice falls short in capturing the comprehensive definition of quality.

3. A nurse on the night shift is making client rounds. When the nurse checks a client who is 97 years old and has successfully been treated for heart failure, he notes that the client is not breathing. If the client does not have a do-not-resuscitate (DNR) order, the nurse should take which action?

• A. Administer cardiopulmonary resuscitation (CPR)
• B. Call the client's health care provider
• C. Administer oxygen to the client and call the health care provider
• D. Contact the nursing supervisor for directions

Correct answer: A

Rationale: Administering cardiopulmonary resuscitation (CPR) is the appropriate action when a client is not breathing and does not have a do-not-resuscitate (DNR) order. CPR is considered an emergency treatment that can be provided without client consent in life-threatening situations. Calling the health care provider or nursing supervisor for directions, as well as administering oxygen without addressing the lack of breathing, would delay critical life-saving interventions. Therefore, administering CPR is the most urgent and necessary action to perform in this scenario.

4. A nurse is reviewing the notes written by a nurse on a previous shift. Which note in the client's record reflects the correct use of guidelines for documentation?

• A. The client's wound is healing well.
• B. The client seems anxious.
• C. The client's intake was 360 mL
• D. The client is voiding large amounts

Correct answer: C

Rationale: Quality documentation and reporting require information to be factual, accurate, complete, current, and organized. Choice C, 'The client's intake was 360 mL,' reflects the correct use of guidelines for documentation as it provides a specific and measurable observation. This note meets the criteria for quality documentation by being specific and quantifiable. Choices A, B, and D lack specificity and quantifiability. Choice A includes a subjective term 'well,' choice B uses 'seems' indicating uncertainty, and choice D uses a vague term 'large' without quantifying the amount.

5. Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be:

• A. Outbreak of Asian flu.
• B. Chemical exposure.
• C. Bacterial pneumonia.
• D. Allergic reaction.

Correct answer: B

Rationale: The most likely cause of groups of individuals suddenly experiencing similar signs of illness all at once is a chemical exposure. In this scenario, considering the sudden onset of symptoms in multiple passengers on an airliner, the symptoms are more indicative of a chemical exposure rather than Asian flu, bacterial pneumonia, or an allergic reaction. Asian flu, bacterial pneumonia, and allergic reactions do not typically manifest in a way that would affect a group of individuals simultaneously. Therefore, the correct diagnosis in this case is likely to be a chemical exposure.

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