Nursing Elites

1. Teresa is an 84-year-old with stage 4 ovarian cancer who has been admitted for a bowel obstruction. She recently stated that she has decided that she doesn't want any further aggressive care and is requesting to be placed under hospice care. Her husband and daughter are supportive of her decision. She spoke with her oncologist about it, and he stated that he did not agree and wrote orders on her chart for chemotherapy. What would be the best first response to this situation?

• A. Give the patient a list of other oncologists
• B. Tell the family to report the doctor to the state quality board
• C. Notify the doctor that the patient refuses the chemotherapy
• D. Give the patient hospice information

Correct answer: C

Rationale: The patient has the right to refuse any treatment, and the doctor should be notified that the orders on the chart cannot be performed, with appropriate documentation. In this situation, the best first response is to notify the doctor that the patient refuses the chemotherapy. This step ensures that the patient's wishes are respected and that inappropriate treatments are not administered. It also opens up a dialogue with the oncologist, giving him the opportunity to understand the patient's perspective and potentially support her decision. Providing hospice information is a good follow-up step after addressing the immediate issue of refusing chemotherapy, as it allows the patient to initiate her own hospice evaluation if desired. Giving the patient a list of other oncologists or telling the family to report the doctor to the state quality board are not appropriate initial responses and may not align with the patient's wishes or autonomy.

2. When a blood pressure cuff is too wide for a client's arm, what type of reading might this blood pressure cuff produce?

• A. A normal reading
• B. An abnormally low reading
• C. An abnormally high reading
• D. A fluctuating reading

Correct answer: B

Rationale: When a blood pressure cuff is too wide for a client's arm, it may produce an abnormally low blood pressure reading. This occurs because the oversized cuff can lead to an underestimation of blood pressure. It is essential to ensure that the cuff fits appropriately to obtain an accurate reading. An abnormally high reading (Choice C) is less likely with an oversized cuff, as it generally leads to lower readings. A normal reading (Choice A) is unlikely due to the inaccuracies caused by the oversized cuff. A fluctuating reading (Choice D) is not a typical result of using a cuff that is too wide; instead, it usually leads to consistently low readings.

3. The discharge planning team is discussing plans for the dismissal of a 16-year-old admitted for complications associated with asthma. The client's mother has not participated in any of the discharge planning processes but has stated that she wants to be involved. Which of the following reasons might prohibit this mother from participating in discharge planning?

• A. The client is an emancipated minor
• B. The mother has to work and is unavailable
• C. The client has a job and a driver's license
• D. The mother does not speak English

Correct answer: A

Rationale: In this scenario, the correct answer is that the client is an emancipated minor. Emancipated minors, even if they are under the age of 18, have the legal right to make decisions about their own healthcare and planning, which may include not wanting their parent involved in the discharge planning process. This status grants them independence from parental involvement in certain situations. The other choices are incorrect because the mother's work schedule, the client's job and possession of a driver's license, and the mother's language proficiency do not inherently prevent her from participating in the discharge planning process, unlike the legal status of being an emancipated minor.

4. In a clinic in a primarily African American community, a higher incidence of uncontrolled hypertension is noted in patients. To correct this health disparity, what should the nurse do first?

• A. Initiate a regular home-visit program by clinic nurses.
• B. Schedule teaching sessions about low-salt diets at community events.
• C. Assess the perceptions of community members about the care at the clinic.
• D. Obtain low-cost antihypertensive drugs using government grant funding.

Correct answer: C

Rationale: To address the higher incidence of uncontrolled hypertension in the primarily African American community, the nurse should first assess the perceptions of community members about the care at the clinic. Understanding the community's perspective can provide valuable insights into the reasons behind the health disparity. Initiating a regular home-visit program or scheduling teaching sessions about low-salt diets are important interventions but should come after gathering information on community perceptions. Obtaining low-cost antihypertensive drugs is not the initial priority; understanding community perspectives is crucial for developing effective interventions.

5. When planning care for an uninsured diabetic patient, which strategy should be a priority?

• A. Obtain less expensive medications
• B. Follow evidence-based practice guidelines
• C. Assist with dietary changes as the first action
• D. Teach about the impact of exercise on diabetes

Correct answer: B

Rationale: The priority when planning care for an uninsured diabetic patient should be to follow evidence-based practice guidelines. By adhering to standardized evidence-based guidelines, the nurse can help reduce healthcare disparities among different socioeconomic groups. While obtaining less expensive medications and assisting with dietary changes are important, the primary concern should be providing care that aligns with established standards of practice. Teaching about the impact of exercise is also valuable but may not be the priority when immediate care planning for an uninsured patient is considered.

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