Nursing Elites

1. Which of the following statements should be included in the teaching to a client about a do-not-resuscitate order (DNR)?

• A. When a heart ceases to beat, the client is pronounced clinically dead.
• B. Physicians are required to write DNR orders.
• C. A DNR order can be written after discussion with the client and family.
• D. A court decision is needed for a DNR.

Correct answer: C

Rationale: The correct statement to include in teaching a client about a do-not-resuscitate (DNR) order is that it can be written after discussion with the client and family. This involves ensuring that the client and their family understand the implications and make an informed decision. Choice A is incorrect as pronouncing clinical death is not directly related to discussing a DNR order. Choice B is incorrect as while physicians typically write DNR orders, it is not a strict requirement. Choice D is incorrect as a court decision is not typically required for a DNR order; it is a decision made by the client with input from healthcare providers and family members.

2. The healthcare provider is caring for a client with pheochromocytoma. Which of the following interventions should the healthcare provider implement?

• A. Administer beta-blockers to control blood pressure
• B. Encourage a high-sodium diet
• C. Monitor for signs of hyperglycemia
• D. Restrict fluid intake to prevent edema

Correct answer: A

Rationale: The correct intervention for a client with pheochromocytoma is to administer beta-blockers to control blood pressure. Pheochromocytoma is a catecholamine-secreting tumor that can cause severe hypertension. Beta-blockers are used to block the effects of catecholamines and help control blood pressure in these clients. Encouraging a high-sodium diet (Choice B) would not be appropriate as it can worsen hypertension. Monitoring for signs of hyperglycemia (Choice C) is not directly related to managing pheochromocytoma. Restricting fluid intake (Choice D) may lead to dehydration and is not a recommended intervention for this condition.

3. When implementing a new policy on the unit, what process should a nurse manager follow?

• A. The nurse manager should involve staff members in the decision-making process, gather input, and communicate the reasons for the policy change to ensure buy-in from the team.
• B. The nurse manager should implement the policy change immediately and monitor staff compliance to ensure that the new policy is being followed.
• C. The nurse manager should delegate the implementation of the policy change to a staff member and provide support as needed to ensure that the change is successful.
• D. The nurse manager should communicate the policy change to staff members, provide training as needed, and monitor the implementation process to ensure that the change is effective.

Correct answer: A

Rationale: When introducing a new policy on the unit, it is essential for the nurse manager to involve staff members in the decision-making process. This approach helps in gathering input and insights from the team, fostering a sense of ownership and commitment. By communicating the reasons behind the policy change, the nurse manager ensures transparency and promotes understanding among the staff, leading to buy-in and acceptance of the new policy. Choice B is incorrect because implementing a policy change without involving staff and explaining the rationale may lead to resistance or lack of understanding. Choice C is not ideal as delegation without active involvement and communication with the team may result in misunderstandings or incomplete implementation. Choice D lacks the crucial step of involving staff in the decision-making process, which is important for successful policy implementation and team engagement.

4. A client with DM asks a nurse why it is necessary to rotate injection sites when using an insulin pen. The nurse's best response would be:

• A. To prevent scar tissue from forming under the skin.
• B. To make the injections less painful.
• C. To help the insulin absorb better.
• D. To keep the skin looking healthy.

Correct answer: C

Rationale: The correct answer is C: "To help the insulin absorb better." Rotating injection sites is important as it helps to ensure better insulin absorption and reduces the risk of developing lipodystrophy. Option A is incorrect as rotating sites primarily aims to optimize insulin absorption, not prevent scar tissue. Option B is inaccurate because rotating injection sites does not necessarily make the injections less painful. Option D is incorrect as the primary reason for rotating injection sites is not related to the aesthetics of the skin but rather to enhance insulin absorption and prevent complications.

5. An RN enters a patient's room to place an indwelling urinary catheter, as ordered by the healthcare professional. The client is alert and oriented and tells the RN he wants to leave the hospital now and not receive further treatment. Which of the following actions by the RN would be considered false imprisonment?

• A. The RN tells the client he is not allowed to leave until the physician has released him.
• B. The RN asks the client why he wishes to leave.
• C. The RN asks the client to explain what he understands about his medical diagnosis.
• D. The RN asks the client to sign an against medical advice discharge form.

Correct answer: A

Rationale: False imprisonment occurs when a person is prevented from leaving against their will. By telling the patient they are not allowed to leave, the RN is restricting the patient’s freedom unlawfully. Choice B is focused on understanding the patient's reasons for leaving and does not involve restricting the patient's freedom. Choice C aims to assess the patient's understanding of their medical condition, which is unrelated to false imprisonment. Choice D involves obtaining consent for leaving against medical advice, which is a legal and ethical process and not false imprisonment.

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