Nursing Elites

1. Why is accurate documentation of assessment findings regarding pressure ulcers crucial?

• A. To comply with legal requirements for documenting lesions.
• B. To meet hospital policies for documenting lesions.
• C. To fulfill physician's documentation requirements for lesions.
• D. Because the nursing assessment of ulcers is a standard of nursing practice.

Correct answer: D

Rationale: Accurate documentation of assessment findings regarding pressure ulcers is crucial because the nursing assessment of ulcers is a standard practice in nursing care. Documenting these findings not only ensures continuity of care but also plays a vital role in preventing further progression of the ulcer. Choices A, B, and C are incorrect because while laws, hospital policies, and physician requirements may influence documentation practices, the primary reason for accurate documentation lies in the standards of nursing practice and the quality of patient care.

2. Which action exemplifies the use of evidence-based practice in the delivery of client care?

• A. Advising a client to agree to the treatment recommended by their healthcare provider
• B. Taking a rectal temperature from a client for whom bleeding precautions have been instituted
• C. Donning sterile gloves to change an abdominal wound dressing
• D. Encouraging a client to take an herbal substance to treat their insomnia

Correct answer: C

Rationale: Evidence-based practice is an approach to client care where the nurse integrates the client’s preferences, clinical expertise, and the best research evidence to deliver quality care. Donning sterile gloves to change an abdominal wound dressing exemplifies evidence-based practice as it prevents the entrance of harmful bacteria into the wound, following best practice guidelines. The other options do not align with evidence-based practice. Advising a client to agree to a treatment does not involve integrating research evidence. Taking herbal substances may not be supported by strong research evidence and can pose risks. Additionally, rectal temperature-taking in a client with bleeding precautions can increase the risk of injury to the rectal mucosa, not aligning with best practices in care delivery.

3. A discharge planning nurse is making arrangements for a client with an epidural catheter for continuous infusion of opioids to be placed in a long-term care facility. The family prefers a facility in its neighborhood to facilitate visiting. The neighborhood facility has never cared for a client with this type of need. What is the most appropriate action by the discharge planning nurse?

• A. Arrange for immediate in-services for the long-term care facility staff on pain management using epidural catheters.
• B. Explain the situation to the client and family and seek another long-term care facility for discharge from the hospital.
• C. Encourage the family to hire private duty nurses skilled in epidural catheter pain management to allow the client to be transferred to the neighborhood facility.
• D. None of the above

Correct answer: B

Rationale: In this scenario, the priority is the safety and well-being of the client. The neighborhood facility's lack of experience in caring for a client with an epidural catheter for continuous opioid infusion raises concerns about the quality of care they can provide. Therefore, the most appropriate action for the discharge planning nurse is to explain the situation to the client and family and seek another long-term care facility that can provide the necessary care. Option A, arranging for immediate in-services, may not be feasible or timely, considering the urgent need for appropriate care. Option C, encouraging the family to hire private duty nurses, does not ensure the facility's overall capability to manage the client's complex needs. Option D, 'None of the above,' is not the best choice as the client's safety should be the priority in this situation.

4. When a 17-year-old client arrives at the clinic suspecting a sexually transmitted infection, what information does the nurse provide concerning informed consent?

• A. She will need to sign an informed consent form.
• B. Her mother or father will need to be contacted for permission to treat her.
• C. A consent form is not needed if the problem is a sexually transmitted infection.
• D. Anyone over the age of 18 years may sign a consent form for her treatment.

Correct answer: A

Rationale: Informed consent is a person's agreement to allow something, such as a treatment, to be performed. A consent form is required even if the problem is a sexually transmitted infection. If the client is a minor, the minor may sign the informed consent form in specific situations, including seeking treatment for a sexually transmitted infection. In this case, the 17-year-old client is seeking examination and treatment for a sexually transmitted infection, so she will need to sign the informed consent form. Contacting her parents for permission is not required in this situation. Choice C is incorrect because a consent form is necessary regardless of the medical issue. Choice D is incorrect because the individual's age is not the determining factor; rather, it is the nature of the medical service being sought that dictates the need for informed consent.

5. A client being treated for sickle cell disease has an order for pain medication. Morphine was ordered, but the nurse is having difficulty deciphering the dose. The nurse should ____.

• A. ask the attending physician to clarify the order, including the correct medication, dose, route, and frequency
• B. call the charge nurse to inform the attending physician and verify the order, including the correct medication, dose, route, and frequency
• C. call the attending physician to verbally verify the order, including the correct medication, dose, route, and frequency
• D. refrain from administering the medication until the charge nurse can assist in determining the correct dosage

Correct answer: C

Rationale: In this scenario, when a nurse encounters difficulties in deciphering an order, the appropriate action is to contact the attending physician directly to clarify and verify the medication, dose, route, and frequency. It is crucial for the nurse to have a clear understanding of the order before administering any medication to ensure patient safety and proper treatment. Option A is incorrect as it suggests asking the attending physician to clarify without specifying the urgency of the situation. Option B involves an unnecessary additional step by first contacting the charge nurse before reaching out to the attending physician, potentially delaying the clarification process. Option D is incorrect as it advises refraining from administering the medication, which may not be necessary if the correct dosage can be promptly verified by contacting the attending physician.

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