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1. A client is refusing a blood transfusion for religious reasons. The client's partner wants the client to have the blood transfusion. Which of the following actions should be taken?
- A. Ask the client to consider a direct donation
- B. Withhold the blood transfusion
- C. Ask the client to consider a direct donation
- D. Request a consultation with the ethics committee
Correct answer: A
Rationale: In this situation, the nurse should ask the client to consider a direct donation. This option respects the client's autonomy by exploring alternative options that align with the client's beliefs. Withholding the blood transfusion (choice B) goes against the client's wishes and autonomy. Requesting a consultation with the ethics committee (choice D) should be considered if there is a disagreement that cannot be resolved at the bedside, but it is not the initial step. Choice C is a duplicate of choice A and does not provide a different or additional action to address the situation.
2. Which patient action indicates a good understanding of the nurse�s teaching about the use of an insulin pump?
- A. The patient programs the pump for an insulin bolus after eating
- B. The patient changes the location of the insertion site every week
- C. The patient takes the pump off at bedtime and starts it again each morning.
- D. The patient plans for a diet that is less flexible when using the insulin pump.
Correct answer: A
Rationale:
3. Recent polls have placed nursing as one of the most trusted professions because of which of the following?
- A. Nurses engage in lifelong learning.
- B. Nurses abide by a dress code.
- C. Nurses have the skills needed to care for diverse populations.
- D. Nurses must pass the NCLEX in order to obtain a license to practice.
Correct answer: C
Rationale: Recent polls have identified nursing as one of the most trusted professions due to nurses possessing the necessary skills to provide care for diverse populations. This includes understanding and addressing the unique needs of individuals from various backgrounds and cultures. Choice A is incorrect because while nurses do engage in lifelong learning, this is not the primary reason for their trustworthiness. Choice B is also incorrect as abiding by a dress code does not directly contribute to the trust placed in nurses. Choice D is incorrect because passing the NCLEX exam is a regulatory requirement for obtaining a license and does not solely determine the trustworthiness of nurses in the eyes of the public.
4. A healthcare professional is preparing to delegate client care tasks to an assistive personnel (AP). Which of the following tasks should the healthcare professional delegate?
- A. Confirming that a client's pain has decreased after receiving an analgesic
- B. Ambulating a client who is postoperative
- C. Inserting an indwelling urinary catheter for a client
- D. Demonstrating the use of an incentive spirometer to a client
Correct answer: A
Rationale: The correct answer is option A: 'Confirming that a client's pain has decreased after receiving an analgesic.' This task involves assessing the effectiveness of the medication, which can be delegated to the assistive personnel. Options B, C, and D involve skills that should be performed by licensed healthcare professionals due to their complexity and potential risks if not done correctly. Ambulating a postoperative client requires monitoring for signs of distress or complications, inserting a urinary catheter involves an invasive procedure with infection risks, and demonstrating the use of medical devices like an incentive spirometer requires specialized knowledge to ensure correct usage.
5. A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to
- A. save the lunch tray for the patient�s later return to the unit
- B. ask that diagnostic testing area staff to start a 5% dextrose IV
- C. send a glass of milk or orange juice to the patient in the diagnostic testing area
- D. request that if testing is further delayed, the patient be returned to the unit to eat.
Correct answer: D
Rationale:
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