Nursing Elites

1. When ethical dilemmas arise, what should newly licensed nurses expect and identify as an ethical dilemma?

• A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment.
• B. A nurse overhears another nurse telling an older adult client that if he doesn’t stay in bed, she will have to apply restraints.
• C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill.
• D. A client who is terminally ill hesitates to name their partner on their durable power of attorney form.

Correct answer: C

Rationale: An ethical dilemma involves a situation where there are conflicting values or principles that make it difficult to make a clear decision. In the given scenarios, option C best represents an ethical dilemma as the family has conflicting feelings about initiating enteral tube feedings for their terminally ill father. This situation presents a clash between different values and beliefs, making it challenging to reach a resolution. Options A, B, and D do not illustrate conflicting values or principles that characterize an ethical dilemma. Option A describes a nurse's impairment, which is a concern but not a direct ethical dilemma. Option B depicts a potential breach of client autonomy and restraint use, which is an ethical issue but not a true ethical dilemma. Option D involves a client's personal decision regarding a durable power of attorney form, which, although important, does not present conflicting values or principles that define an ethical dilemma.

2. A client reports constipation, and a nurse is providing dietary teaching. Which of the following foods should the nurse recommend?

• A. Macaroni and cheese
• B. One medium apple with skin
• C. One cup of plain yogurt
• D. Roast chicken and white rice

Correct answer: B

Rationale: The correct answer is B: One medium apple with skin. Foods high in fiber, like apples with skin, are recommended to relieve constipation due to their fiber content, which aids in bowel regularity. Macaroni and cheese, yogurt, and roast chicken with white rice do not provide as much fiber and are less effective in alleviating constipation. While yogurt can sometimes contain probiotics that support gut health, it is not as effective in treating constipation as high-fiber foods like apples.

3. A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit, the nurse observes the client smacking her lips alternately with grinding her teeth. The nurse recognizes this assessment finding as what?

• A. Dystonia
• B. Akathisia
• C. Bradykinesia
• D. Tardive dyskinesia

Correct answer: D

Rationale: The correct answer is D: Tardive dyskinesia. Tardive dyskinesia is a potential side effect of long-term antipsychotic use, characterized by involuntary movements like lip smacking and repetitive, purposeless movements. Choice A, dystonia, presents with sustained or repetitive muscle contractions. Choice B, akathisia, involves motor restlessness and a compelling need to be in constant motion. Choice C, bradykinesia, refers to slowness of movement typically seen in Parkinson's disease, not lip smacking and teeth grinding, which are indicative of tardive dyskinesia.

4. A client is being taught how to administer ear drops. Which of the following statements should the nurse identify as an indication that the client understands?

• A. I will straighten my ear canal by pulling my ear down and back.
• B. I will gently apply pressure with my finger to the front part of my ear after putting in the drops.
• C. I will insert the nozzle of the ear drop bottle snugly into my ear before squeezing the drops in.
• D. After the drops are in, I will place a cotton ball all the way into my ear canal.

Correct answer: B

Rationale: The correct answer is B. Gently applying pressure to the front part of the ear after administering drops helps with absorption. Pulling the ear down and back is a correct technique for adults. Snugly inserting the nozzle of the ear drop bottle or placing a cotton ball all the way into the ear canal is unnecessary and can potentially cause harm or discomfort. Therefore, choices A, C, and D are incorrect.

5. Which statement best describes time management strategies applied to the role of a nurse manager?

• A. Schedule staff efficiently to cover the needs of the managed unit
• B. Assume a fair share of direct client care to set an example
• C. Set daily goals with a prioritization of tasks
• D. Delegate tasks to reduce workload associated with direct care and meetings

Correct answer: C

Rationale: Setting daily goals and prioritizing tasks is crucial for effective time management as a nurse manager. This approach helps in organizing and focusing on the most important responsibilities, ensuring that key tasks are completed efficiently. Choice A is incorrect as scheduling staff efficiently, while important, is more related to staffing management than direct time management strategies. Choice B is incorrect as assuming direct client care does not necessarily align with effective time management strategies for a nurse manager, as their primary role is overseeing and coordinating care. Choice D, while delegation is a key aspect of time management, the emphasis on reducing workload specifically associated with direct care and meetings may not always be the primary focus of a nurse manager's time management strategies.

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