Nursing Elites

1. A new nursing unit is opening in the hospital. In order to meet the staffing needs of the unit, nurses from other areas will be moved and required to work in the new area. When notifying the nurses chosen to staff this area, the nurse manager states, 'You will either move to work on this unit or you will no longer be employed at this hospital.' Which of the following strategies is this nurse manager using?

• A. Manipulation
• B. Facilitation
• C. Co-optation
• D. Coercion

Correct answer: D

Rationale: The nurse manager in this scenario is using a coercion tactic to influence the nurses' job changes. Coercion involves using power to force others to make a choice. In this case, the nurses are left with no option but to either work on the new unit or face termination. Choice A, 'Manipulation,' is incorrect as manipulation involves influencing others through deceit or dishonesty, which is not evident in this situation. Choice B, 'Facilitation,' is incorrect as it refers to the process of making something easier or more convenient, which is not applicable here. Choice C, 'Co-optation,' involves absorbing or integrating individuals into a group, which does not align with the scenario described. Therefore, the most suitable term for the nurse manager's strategy is 'Coercion.'

2. As you are assessing the fetus during labor, you are determining the fetal lie, presentation, attitude, station, and position. Your client asks you what all these assessments are. Among other things, how should you respond to the mother?

• A. You should explain that fetal lie is where the fetus's presenting part is within the birth canal during labor, among other information about the other assessments.
• B. You should explain that fetal presentation is the relationship of the fetus's spine to the mother's spine, among other information about the other assessments.
• C. You should explain that fetal attitude is the relationship of the fetus's presenting part to the anterior, posterior, right, or left side of the mother's pelvis, among other information about the other assessments.
• D. You should explain that fetal station is the level of the fetus's presenting part in relationship to the mother's ischial spines, among other information about the other assessments.

Correct answer: D

Rationale: You should explain that fetal station is the level of the fetus's presenting part in relationship to the mother's ischial spines. Fetal station is measured in terms of the number of centimeters above or below the mother's ischial spines. When the fetus is 1 to 5 centimeters above the ischial spines, the fetal station is -1 to -5, and when the fetus is 1 to 5 centimeters below the level of the maternal ischial spines, the fetal station is +1 to +5. Choices A, B, and C provide incorrect information about fetal lie, presentation, and attitude, respectively, which do not align with the definitions of these terms in obstetrics.

3. Which of the following reasons would be legal when considering a patient's medical record?

• A. Allowing a patient's brother to view her chart to find out her birthdate and address so that he can mail her a card
• B. Not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing
• C. Not allowing a patient to view her chart because she is behind on her payments
• D. All of the above are legal

Correct answer: B

Rationale: The correct answer is not allowing a patient to view her own chart because the physician feels this information would be detrimental to her wellbeing. Physicians have a duty to withhold certain health information from patients if disclosing it could potentially harm the patient. In situations where revealing certain information may have a significantly negative impact on the patient's mental or physical health, healthcare providers have the legal right to withhold that information. Allowing a patient's brother to view her chart for non-medical reasons like sending a card is not a valid legal reason for disclosing patient information. Similarly, refusing access based on financial reasons is not a legal ground for restricting access to a patient's medical record as patient care should not be influenced by financial matters.

4. A victim of a gunshot wound to the abdomen has been admitted to the hospital, accompanied by a police officer. When questioned, the officer states that the patient is a suspect in a homicide, which occurred as part of the same incident. A small child was killed as the result of a stray bullet. The patient is combative, yells that he's in pain and demands medication. What is your most appropriate response?

• A. Tell him you'll take care of him after your other patients
• B. Reinforce restraints
• C. Perform a pain assessment and administer pain medication
• D. Ask the officer for more details of the incident

Correct answer: C

Rationale: The most appropriate and caring response is to perform a pain assessment and administer the pain medication that has been ordered. Regardless of personal feelings about any given situation, the nurse's responsibility is to provide unbiased, appropriate, and supportive care, as stated in the American Nurses Association (ANA) Code of Ethics. Choice A is not appropriate as it disregards the patient's immediate need for pain relief. Choice B may escalate the situation and is not the priority in this case. Choice D is not the immediate action needed to address the patient's pain and distress.

5. A nurse is caring for an 83-year-old man who has had swallowing difficulties. All of the following interventions are appropriate for this client EXCEPT:

• A. Keep the client in an upright position at all times
• B. Auscultate lung sounds every shift and after feedings
• C. Maintain suction equipment at the client's bedside
• D. Instruct the client about how to perform swallowing exercises

Correct answer: A

Rationale: When caring for a client with swallowing difficulties, it is crucial to prevent aspiration of food into the lungs. Appropriate interventions include auscultating lung sounds every shift and after feedings to assess for any changes in breathing patterns, maintaining suction equipment at the client's bedside in case of difficulties, and providing instruction on swallowing exercises. Keeping the client in an upright position at all times is not necessary and may not always be feasible or comfortable for the client. This rigid requirement is not part of the standard care protocol for managing swallowing difficulties.

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