Nursing Elites

1. Tommy R., your 68-year-old patient, is at risk for falls. He has fallen 3 times in the last month. You should keep Tommy's ______________ in order to prevent him from falling again.

• A. bedside rails up at all times
• B. bed in the low position
• C. call bell within reach
• D. family members in the room at all times

Correct answer: C

Rationale: To prevent falls, it is essential to keep the patient's call bell within reach so they can easily call for help when needed. This allows for timely assistance and can prevent falls. While low beds can reduce the severity of injuries in case of a fall, they do not prevent falls from happening. Having family members in the room at all times is not a realistic or practical solution. Side rails can actually increase the severity of falls as patients may attempt to climb over them, and using side rails as fall prevention is considered a restraint practice that can lead to entrapment and other risks.

2. What ethical principle has led to the need for informed consent?

• A. Autonomy
• B. Justice
• C. Fidelity
• D. Beneficence

Correct answer: A

Rationale: Autonomy is the ethical principle that emphasizes an individual's right to make their own decisions if they are mentally competent. Informed consent is a direct result of this principle, as it ensures that patients are fully informed before agreeing to any medical intervention. Autonomy is crucial in healthcare as it respects patients' rights and promotes self-determination. Justice, fidelity, and beneficence are important ethical principles in healthcare, but they do not directly lead to the need for informed consent. Justice focuses on fairness and equal treatment, fidelity on trustworthiness and loyalty, and beneficence on doing good for the patient's benefit.

3. A 27-year-old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign staff to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is hyperactive and may engage in injurious activities, setting realistic limits to the client's behavior is crucial to ensure safety. A quiet environment with firm and consistent limits helps in managing the client's behavior effectively. While repeating verbal instructions can be helpful due to the client's distractibility, it is not the priority compared to setting limits for safety concerns. Allowing the client to express feelings is important, but it should be done through non-destructive methods. Assigning staff to be with the client at all times is not realistic or feasible in the clinical setting and does not address the core issue of managing the client's behavior and ensuring safety.

4. Mr. N is a client who entered the hospital with a diagnosis of diabetic ketoacidosis. The nurse enters his room to check his vital signs and finds him breathing at a rate of 32 times per minute; his respirations are deep and regular. Which type of respiratory pattern is Mr. N most likely exhibiting?

• A. Kussmaul respirations
• B. Cheyne-Stokes respirations
• C. Biot's respirations
• D. Cluster breathing

Correct answer: A

Rationale: Mr. N is exhibiting Kussmaul respirations, characterized by rapid, deep, and regular breathing. This type of respiratory pattern is commonly seen in metabolic acidosis, such as in diabetic ketoacidosis. Kussmaul respirations are a form of hyperventilation, leading to the elimination of carbon dioxide from the body. Choice B, Cheyne-Stokes respirations, is characterized by alternating periods of deep, rapid breathing followed by periods of apnea and is not typically associated with diabetic ketoacidosis. Choice C, Biot's respirations, involve irregular breathing patterns with periods of apnea and are not reflective of the described breathing pattern. Cluster breathing, as mentioned in Choice D, is not a recognized term in respiratory patterns and does not describe the breathing pattern observed in Mr. N.

5. A new nursing unit is opening in the hospital. In order to meet the staffing needs of the unit, nurses from other areas will be moved and required to work in the new area. When notifying the nurses chosen to staff this area, the nurse manager states, 'You will either move to work on this unit or you will no longer be employed at this hospital.' Which of the following strategies is this nurse manager using?

• A. Manipulation
• B. Facilitation
• C. Co-optation
• D. Coercion

Correct answer: D

Rationale: The nurse manager in this scenario is using a coercion tactic to influence the nurses' job changes. Coercion involves using power to force others to make a choice. In this case, the nurses are left with no option but to either work on the new unit or face termination. Choice A, 'Manipulation,' is incorrect as manipulation involves influencing others through deceit or dishonesty, which is not evident in this situation. Choice B, 'Facilitation,' is incorrect as it refers to the process of making something easier or more convenient, which is not applicable here. Choice C, 'Co-optation,' involves absorbing or integrating individuals into a group, which does not align with the scenario described. Therefore, the most suitable term for the nurse manager's strategy is 'Coercion.'

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