Nursing Elites

1. How should a healthcare professional care for a client approaching death with shortness of breath and noisy respirations?

• A. Turn the client every 2 hours
• B. Provide supplemental oxygen
• C. Use a fan to reduce the feeling of breathlessness
• D. Administer diuretics as prescribed

Correct answer: C

Rationale: In a palliative care setting, when caring for a client approaching death with symptoms of shortness of breath and noisy respirations, using a fan can help alleviate the sensation of breathlessness. This intervention can provide comfort by improving air circulation and reducing the perception of breathlessness. Turning the client every 2 hours may not directly address the respiratory distress caused by noisy respirations. Providing supplemental oxygen may not be indicated or effective in all cases, especially in end-of-life care where the focus is on comfort rather than aggressive interventions. Administering diuretics as prescribed would not be appropriate for addressing noisy respirations and shortness of breath in a dying client, as this may not be related to fluid overload or congestion. Therefore, the most appropriate action to help the client feel more comfortable in this situation is to use a fan to reduce the feeling of breathlessness.

2. A nurse is preparing to administer 0.5 mL of oral single-dose liquid medication to a client. Which of the following actions should the nurse take?

• A. Gently shake the container of medication prior to administration
• B. Transfer the medication to a medicine cup
• C. Place the client in a semi-Fowler’s position for medication administration
• D. Verify the dosage by measuring the liquid before administering it

Correct answer: A

Rationale: The correct action for the nurse to take is to gently shake the container of liquid medication before administration. Shaking the container ensures proper mixing of the medication, which is important to maintain uniformity of the dose. Transferring the medication to a medicine cup (choice B) may not be necessary for a small volume like 0.5 mL. Placing the client in a semi-Fowler's position (choice C) is not directly related to administering liquid medication orally. Verifying the dosage by measuring the liquid (choice D) is important but does not address the specific action needed to prepare the medication for administration.

3. What action should the nurse take to prevent the development of deep vein thrombosis (DVT) in a client who is postoperative day 2 following hip replacement surgery?

• A. Encourage the client to remain on bed rest as much as possible.
• B. Apply sequential compression devices (SCDs) to the client's legs.
• C. Massage the client's legs to improve circulation.
• D. Encourage the client to perform ankle and foot exercises.

Correct answer: B

Rationale: The correct action to prevent DVT in a postoperative client is to apply sequential compression devices (SCDs) to promote venous return. This helps prevent stasis of blood in the lower extremities, reducing the risk of clot formation. Encouraging bed rest (Choice A) may lead to decreased mobility and increase the risk of DVT. Massaging the client's legs (Choice C) is contraindicated in the presence of DVT as it can dislodge a clot. Encouraging ankle and foot exercises (Choice D) may be beneficial for circulation, but SCDs are more effective at preventing DVT in this scenario.

4. 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.

5. A client is scheduled for an appendectomy and has given informed consent. Which statement by the client should the nurse address first preoperatively?

• A. “I am afraid to walk if it hurts too much.”
• B. “I don’t understand why I need this surgery.”
• C. “I don’t want my family helping me after the surgery.”
• D. “I am afraid the scar will make me look disfigured.”

Correct answer: B

Rationale: The nurse should address the client's lack of understanding regarding the need for surgery first. Ensuring that the client comprehends the rationale for the procedure is essential for informed consent. Choices A, C, and D, while important, do not directly impact the client's understanding of the necessity of the surgery and can be addressed after clarifying the reason for the procedure.

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