Nursing Elites

1. When a client's postoperative pain seems to be getting worse due to grief over the recent death of their spouse, what should the nurse consider?

• A. calling the physician for an increased dosage of pain medication
• B. calling the physician for a sedative
• C. referring the client for a psychiatric consult
• D. developing interventions for grief and loss

Correct answer: D

Rationale: The correct answer is developing interventions for grief and loss. In this scenario, the client's pain is not solely sensory but also affective due to grieving over the death of their spouse. It is essential to address the emotional component of pain by providing support and interventions for grief and loss. Referring the client for a psychiatric consult may not be necessary as grieving is a normal response to such a significant loss. Calling the physician for an increased dosage of pain medication or a sedative solely focuses on the sensory aspect of pain and does not address the underlying emotional distress.

2. Which of the following statements indicates adequate dietary understanding in a client with constipation?

• A. "I should decrease my intake of fluids."?
• B. "I should decrease my level of activity."?
• C. "I should increase my intake of apples."?
• D. "I should increase my intake of milk."?

Correct answer: C

Rationale: The correct answer is, "I should increase my intake of apples."? This statement indicates adequate dietary understanding in a client with constipation because apples are a good source of fiber, which helps alleviate constipation. Adequate fiber intake is essential for promoting bowel regularity. Choices A and B are incorrect as decreasing fluids and activity level can worsen constipation. Insufficient fluid intake can lead to hard stools, exacerbating constipation. Decreasing activity can also slow down bowel movements. Choice D is incorrect because milk is not a high-fiber food and may not effectively address constipation. While milk can have a mild laxative effect on some individuals, it is not a primary solution for constipation, especially when compared to high-fiber foods like apples.

3. A nurse calls a health care provider to question a prescription written for a higher-than-normal dosage of morphine sulfate. The health care provider changes the prescription to a dosage within the normal range, and the nurse documents the new telephone prescription in accordance with the agency's guidelines in the client's record. Which other statement does the nurse document in the nursing notes?

• A. The health care provider made a mistake in the written prescription for morphine sulfate.
• B. An inaccurate dosage of morphine sulfate was prescribed and the health care provider was informed.
• C. The health care provider was contacted to correct a mistake in the dosage of morphine sulfate.
• D. The health care provider was contacted to clarify the prescription for morphine sulfate

Correct answer: D

Rationale: The nurse needs to document a factual, descriptive, and objective statement that does not include words indicating that an individual made a mistake or performed an incorrect action or procedure. If a health care provider's prescription must be questioned, the nurse should record that clarification regarding the prescription was sought. Therefore, the correct statement to document is that the health care provider was contacted to clarify the prescription for morphine sulfate. Choices A, B, and C imply errors or mistakes on the part of the health care provider, which is not the focus of the documentation in this scenario.

4. Which of the following nursing diagnoses is most appropriate for a client with a new colostomy?

• A. Excess Fluid Volume
• B. Risk for Aspiration
• C. Disturbed Body Image
• D. Urinary Retention

Correct answer: C

Rationale: Disturbed Body Image is the most appropriate nursing diagnosis for a client with a new colostomy. A new colostomy can significantly impact a person's body image and self-esteem due to the physical changes it brings. This can lead to emotional distress, adjustment issues, and concerns about body image. Excess Fluid Volume, Risk for Aspiration, and Urinary Retention are not directly related to the psychosocial impact of a new colostomy and are therefore not as relevant in this context. While Excess Fluid Volume, Risk for Aspiration, and Urinary Retention are important nursing diagnoses, they are not the priority when considering the psychological and emotional effects of a new colostomy.

5. A client has experienced a CVA with right hemiparesis and is ready for discharge from the hospital to a long-term care facility for rehab. To provide optimal continuity of care, the nurse should do all of the following except:

• A. document the current functional status
• B. have the physician fax a report to the receiving facility
• C. copy appropriate parts of the medical record for transport to the receiving facility
• D. phone a report to the facility

Correct answer: B

Rationale: To ensure optimal continuity of care for a client transitioning to a long-term care facility for rehab after a CVA, the nurse plays a crucial role in communication. Documenting the current functional status is essential for the receiving facility to plan appropriate care. Copying relevant parts of the medical record for transport provides important background information. Phoning a report directly to the facility is a direct and effective way to communicate the client's condition and care plan. However, having the physician fax a report to the receiving facility introduces an extra step that may delay essential information transfer and increase the risk of miscommunication. Therefore, it is not the optimal choice for ensuring seamless continuity of care.

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