Nursing Elites

1. Which of the following foods can cause diarrhea when consumed by a client with an ileostomy?

• A. eggs
• B. coffee
• C. fish
• D. garlic

Correct answer: B

Rationale: The correct answer is coffee. Coffee can cause diarrhea in clients with an ileostomy due to its stimulating effect on the digestive system, leading to increased bowel movements. Eggs, fish, and garlic are less likely to cause diarrhea in individuals with an ileostomy. However, they may contribute to odor due to the way they are digested and broken down in the body, affecting the smell of stool output but not necessarily causing diarrhea.

2. When assessing a client with terminal cancer receiving a continuous intravenous infusion of morphine sulfate, what should the nurse check first?

• A. Temperature
• B. Respiratory status
• C. Pulse
• D. Urine output

Correct answer: B

Rationale: When assessing a client with terminal cancer receiving morphine sulfate via continuous intravenous infusion, the nurse's priority should be checking the client's respiratory status first. Morphine sulfate can lead to respiratory depression, emphasizing the need for close monitoring of breathing. While temperature, pulse, and urine output are all essential components of the assessment, ensuring adequate respiratory function takes precedence due to the potential risk of respiratory depression associated with morphine sulfate. Promptly assessing respiratory status enables early identification of any signs of respiratory distress or depression, allowing for immediate intervention if needed.

3. A nurse in a medical-surgical unit overhears the nursing staff openly discussing a client and stating that the client is uncooperative and a real pain to care for. The nurse would most appropriately manage this issue by taking which action?

• A. Leaving articles about judgmental opinions in the nurses' report room
• B. Reporting the nurses' comments to administration
• C. Discouraging the judgmental comments
• D. Ignoring the comments made about the client

Correct answer: C

Rationale: Nurses must discuss clients in a professional manner and avoid using judgmental language such as 'uncooperative' or 'difficult.' When such comments and language are discouraged, fewer comments will be made. Ignoring the comments is an inappropriate option because the concern will not be addressed. Leaving articles about judgmental opinions in the nurses' report room indirectly addresses the issue, but there is no guarantee that the staff will read them. Reporting the nurses' comments to administration does not directly address the issue. The best approach for the nurse is to discourage judgmental comments directly with the staff members. Since this action is not provided in the options, discouraging judgmental comments is the most appropriate way to manage this concern.

4. A health care provider repeatedly asks a nurse to write his verbal prescriptions in his clients' charts after he makes his rounds. The nurse is uncomfortable with writing the prescriptions and explains this to the health care provider, but the health care provider tells the nurse that she will be reported if she does not write the prescriptions. How should the nurse manage this conflict?

• A. Stating to the health care provider, 'I don't really care whether you report me. I am not writing your prescriptions.'
• B. Fulfilling the health care provider's request
• C. Discussing the situation with the nurse manager
• D. Reporting the health care provider to the chief of medicine at the hospital

Correct answer: C

Rationale: When a conflict arises, it is most appropriate to try resolving the conflict directly. In this situation, the nurse has tried to explain why she is uncomfortable with the health care provider's request but has been unable to resolve the conflict. The nurse would then most appropriately use organizational channels of communication and discuss the issue with the nurse manager, who would then proceed to resolve the conflict. The nurse manager may attempt to discuss the situation with the health care provider or seek assistance from the nursing supervisor. Fulfilling the health care provider's request and writing the prescriptions in the clients' charts ignores the issue. Reporting the health care provider to the chief of medicine is inappropriate because the nurse should use the appropriate organizational channels of communication to resolve the conflict. Stating 'I don't really care whether you report me. I am not writing your prescriptions.' is an inappropriate statement and will result in further conflict between the nurse and health care provider.

5. When ambulating a client with right-sided weakness, a nursing assistant should be positioned on which side of the client?

• A. Stands behind the client
• B. Positions the free hand on the client's shoulder
• C. Stands on the right side of the client
• D. Grasps the security belt in the midspine area of the small of the client's back

Correct answer: C

Rationale: When ambulating a client with right-sided weakness, the nursing assistant should stand on the affected side, which in this case is the client's right side. This position allows the assistant to provide proper support and assistance. Standing behind the client (Choice A) is incorrect as the assistant should be on the affected side. Positioning the free hand on the client's shoulder (Choice B) is a correct action as it helps in pulling the client toward them in case of a forward fall. Grasping the security belt in the midspine area of the small of the client's back (Choice D) is also correct to provide support and stability during ambulation.

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