Nursing Elites

1. After a lengthy explanation of a medical procedure, the patient asks many questions. The physician answers all of the questions to the best of their ability. The patient then gives consent for treatment. The costly equipment and supplies are put into place, and the patient is prepared. Two minutes before the procedure is to start, the patient begins panicking and changes their mind. Which of the following situations would be the best way to avoid litigation?

• A. Document that the patient originally gave consent and proceed if the benefits of the procedure outweigh the patient's wishes.
• B. Have the patient sign a form stating that they are refusing consent. If they refuse to sign, do not proceed with the procedure.
• C. Repeat the explanation of the procedure until the patient understands that having the procedure done is the best form of treatment. Do not proceed with the procedure.
• D. Do not proceed. Document the patient's refusal, have the patient sign a refusal to consent to treatment. If the patient refuses to sign the form, have a witness available to sign.

Correct answer: D

Rationale: In this scenario, the best course of action to avoid litigation is to respect the patient's right to refuse treatment, especially when changing their mind before the procedure starts. By not proceeding with the treatment, documenting the patient's refusal, and having the patient sign a refusal to consent form, you are following proper ethical and legal procedures. If the patient refuses to sign the form, having a witness available to sign further strengthens the documentation of the patient's decision. This approach ensures that the patient's autonomy and right to make informed decisions about their healthcare are respected. Choices A, B, and C do not prioritize the patient's right to refuse treatment and could potentially lead to legal issues if treatment is carried out against the patient's wishes.

2. During an adolescent examination, the nurse asks a 13-year-old female to bend forward at the waist with arms hanging freely. Which of the following assessments is the nurse most likely conducting?

• A. Spinal flexibility
• B. Leg length disparity
• C. Hypostatic blood pressure
• D. Scoliosis

Correct answer: D

Rationale: The correct answer is scoliosis. During the assessment for scoliosis, the nurse asks the adolescent to bend forward at the waist with arms hanging freely to observe for any lateral deviation of the spine, uneven rib levels, or asymmetry. This assessment is a routine part of an adolescent examination, especially in females, as scoliosis is more common in this population. Choices A, B, and C are incorrect. Spinal flexibility is usually assessed through different maneuvers, leg length disparity is evaluated by measuring the length of the legs, and hypostatic blood pressure refers to a decrease in blood pressure due to immobility.

3. Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal?

• A. The adolescent gives away a DVD player and a cherished autographed picture of a performer.
• B. The adolescent runs out of group therapy, swearing at the group leader, and then goes to her room.
• C. The adolescent becomes angry while speaking on the phone and slams down the receiver.
• D. The adolescent gets angry with her roommate when the roommate borrows her clothes without asking.

Correct answer: A

Rationale: The correct answer is when the adolescent gives away a DVD player and a cherished autographed picture of a performer. This behavior is concerning because a depressed suicidal client often gives away things of value as a way of saying goodbye and wanting to be remembered. Choices B, C, and D all involve anger and acting-out behaviors, which are common in adolescents but do not specifically indicate suicidal ideation. Running out of group therapy, swearing, and going to her room, becoming angry and slamming the phone receiver, or getting upset when her roommate borrows her clothes are not clear indications of suicidal thoughts.

4. The nurse practicing in a maternity setting recognizes that the postmature fetus is at risk due to:

• A. Excessive fetal weight
• B. Low blood sugar levels
• C. Depletion of subcutaneous fat
• D. Progressive placental insufficiency

Correct answer: D

Rationale: A postmature or postterm pregnancy occurs when a pregnancy exceeds the typical term of 38 to 42 weeks. In this situation, the fetus is at risk due to progressive placental insufficiency. This occurs because the placenta loses its ability to function effectively after 42 weeks. The accumulation of calcium deposits in the placenta reduces blood perfusion, oxygen supply, and nutrient delivery to the fetus, leading to potential growth problems. Choices A, B, and C are incorrect because excessive fetal weight, low blood sugar levels, and depletion of subcutaneous fat are not the primary risks associated with postmature fetuses. The main concern lies in the compromised placental function and its impact on fetal well-being.

5. A nurse is providing dismissal instructions for a child who was admitted for rotavirus. Which of the following statements by the parent indicates the need for further teaching?

• A. I'll start giving him his antibiotics as soon as we get home.
• B. I will call the physician if he becomes dizzy or overly fussy.
• C. He will need to wash his hands a lot to keep this from spreading.
• D. I'll watch to see when he stops having diarrhea stools.

Correct answer: A

Rationale: The correct answer is 'I'll start giving him his antibiotics as soon as we get home.' Rotavirus is a viral illness, and antibiotics are ineffective for its treatment. The parent's statement indicates a need for further teaching as antibiotics are not appropriate for treating rotavirus. Option B is correct as it demonstrates the parent's understanding of when to contact the physician for concerning symptoms. Option C is a correct statement regarding infection control practices. Option D is also correct as monitoring diarrhea stools is essential to track recovery from rotavirus.

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