Nursing Elites

1. When observing a dressing change by a graduate nurse on a Stage III pressure ulcer to the greater trochanter by the staff nurse, a need for further teaching is indicated after the following observation by the nurse:

• A. The new graduate nurse irrigates the pressure ulcer with 50cc of NS.
• B. The new graduate irrigates the pressure ulcer with half-strength hydrogen peroxide.
• C. The new graduate packs the wound with sterile kerlix soaked in NS.
• D. The new graduate applies a Duoderm dressing over the wound after cleansing.

Correct answer: B

Rationale: The correct answer is that the new graduate irrigates the pressure ulcer with half-strength hydrogen peroxide. Pressure ulcers should not be cleaned with substances that are cytotoxic, such as hydrogen peroxide or betadine. This can cause further damage to the wound and delay the healing process. Choice A is incorrect because irrigating the pressure ulcer with normal saline is an appropriate practice. Choice C is incorrect because packing the wound with sterile kerlix soaked in normal saline is also an appropriate step. Choice D is incorrect because applying a Duoderm dressing after cleansing is a standard procedure in wound care.

2. The nurse is caring for a client awaiting test results on a biopsy. The client is unconscious, and the physician informs the client's spouse that the biopsy came back positive for cancer. The spouse asks the nurse if they will not share this news with the client because they would prefer the client be unaware of the diagnosis. Which of the following responses is most appropriate?

• A. "I will have a psychiatrist confirm whether the news will cause negative effects, and if so, I will comply with your request."?
• B. "For ethical reasons, I am unable to withhold this information from the client."?
• C. "You do not have the option to sign paperwork stating you are accepting the risk of not sharing this with the client."?
• D. "You must have a durable power of attorney for healthcare advanced directive in place before I can consider this request."?

Correct answer: B

Rationale: The correct response is, "For ethical reasons, I am unable to withhold this information from the client."? The ethical principle of veracity requires that the nurse is truthful with the client and does not withhold information even if it is requested by the family. Choice A is incorrect because seeking a psychiatrist's confirmation is not necessary to uphold the ethical principle of truth-telling. Choice C is incorrect as implying that signing paperwork overrides the nurse's ethical obligation to be honest with the client is inappropriate. Choice D is also incorrect as a durable power of attorney is not relevant in this situation where the spouse is asking the nurse to withhold information.

3. The nurse is preparing to administer the 9 am dose of IV antibiotics when she notes the IVAC cord is frayed with wiring visible. What action should be her priority for this client?

• A. Notify maintenance to come and check the pump immediately.
• B. Continue with the administration of the antibiotic and fill out an equipment maintenance request.
• C. Immediately discontinue the use of this IVAC pump and obtain a replacement.
• D. Tag the equipment for maintenance.

Correct answer: C

Rationale: The correct action is to immediately discontinue the use of the IVAC pump and obtain a replacement because the frayed cord poses a safety risk to the client. Continuing to use the pump with visible wiring could lead to electric shock or other serious harm to the client. Notifying maintenance to come and check the pump immediately (Choice A) may cause unnecessary delays in ensuring the client's safety. Continuing with the administration of the antibiotic and filling out an equipment maintenance request (Choice B) is unsafe as it ignores the immediate danger. Tagging the equipment for maintenance (Choice D) does not address the urgent need to protect the client from harm.

4. Which of these statements is true regarding advance directives?

• A. They must be reviewed and re-signed every 10 years in order to remain valid.
• B. An advance directive is legally valid in every state, regardless of the state it was created in.
• C. A physician must determine when a client is unable to make medical decisions for themselves.
• D. They cannot be honored by EMTs (emergency medical technicians) unless signed by a doctor.

Correct answer: D

Rationale: The correct statement is that advance directives cannot be honored by EMTs unless they are signed by a doctor. EMTs are required to provide emergency care to a client, irrespective of their advance directive status, unless the directive has been signed by a doctor. When a client is brought to the hospital, physicians will assess the client and implement the advance directive if necessary. Advance directives do not need to be reviewed and re-signed every 10 years to remain valid; they remain in effect until changed. While advance directives are legally valid in most states, some states may not honor those created in other states, so it's advisable to check the new state's policies if a client moves. Additionally, it typically requires two physicians, not just one, to determine if a client is unable to make medical decisions for themselves.

5. While caring for the following clients, a pediatric nurse tells the charge nurse she must leave due to a family emergency. Which client would the charge nurse reassign to an LPN?

• A. An eight-year-old in diabetic ketoacidosis
• B. A six-year-old in sickle cell crisis
• C. A two-month-old with dehydration
• D. A five-year-old in skeletal traction

Correct answer: D

Rationale: The correct answer is a five-year-old in skeletal traction. This task is within the scope of practice for an LPN and would need minimal assistance from an RN. The children with diabetic ketoacidosis, sickle cell crisis, and dehydration require close observation, good assessment skills, IVF needs, and medications that would be better managed by an RN. Reassigning the child in skeletal traction to an LPN ensures appropriate care while allowing the RN to focus on the more critical cases.

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