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. A female client with physical findings suggestive of a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, necessitating a transsphenoidal hypophysectomy. The evening before the surgery, Nurse Jacob reviews preoperative and postoperative instructions provided to the client earlier. Which postoperative instruction should the nurse emphasize?

• A. You must lie flat for 24 hours after surgery.
• B. You must avoid coughing, sneezing, and blowing your nose.
• C. You must restrict your fluid intake.
• D. You must report ringing in your ears immediately.

Correct answer: B

Rationale: Following a transsphenoidal hypophysectomy, it is crucial to avoid activities such as coughing, sneezing, and blowing the nose to prevent an increase in intracranial pressure or the risk of cerebrospinal fluid leakage. Coughing, sneezing, or nose blowing can strain the surgical site, potentially leading to complications. Lying flat for 24 hours is not typically required after this surgery. Fluid intake should be encouraged to prevent dehydration. Ringing in the ears is not a common complication associated with this type of surgery.

3. A client is diagnosed with hyperthyroidism. The nurse anticipates which of the following medications to be ordered?

• A. Levothyroxine
• B. Propylthiouracil
• C. Lithium
• D. Metoprolol

Correct answer: B

Rationale: The correct answer is B: Propylthiouracil. Propylthiouracil is an antithyroid medication used to manage hyperthyroidism by inhibiting the synthesis of thyroid hormones. Levothyroxine (Choice A) is typically used to treat hypothyroidism, the opposite of hyperthyroidism. Lithium (Choice C) is not used to treat hyperthyroidism but is commonly used to manage bipolar disorder. Metoprolol (Choice D) is a beta-blocker that may be used to manage symptoms like tachycardia associated with hyperthyroidism, but it is not the primary treatment for the condition.

4. Why might an RN need professional liability insurance?

• A. Protection against frivolous lawsuits without incurring expenses.
• B. Immunity from being sued by the institution if guilty of malpractice.
• C. Coverage for charges of libel, slander, assault, and HIPAA violations.
• D. Exclusively doctors face malpractice lawsuits.

Correct answer: C

Rationale: Having professional liability insurance is crucial for Registered Nurses due to various reasons. Choice A is incorrect because there are expenses associated with defending against frivolous lawsuits. Choice B is incorrect as institutions can still sue a nurse found guilty of malpractice. Choice D is incorrect because malpractice lawsuits can be filed against healthcare professionals, including nurses. Therefore, the correct answer is C, as liability policies can provide coverage for charges involving libel, slander, assault, and breaches of patient confidentiality like HIPAA violations, offering essential protection for RNs in their practice.

5. The client with newly diagnosed diabetes mellitus is being taught about managing blood glucose levels. Which statement indicates a need for further teaching?

• A. I will rotate my insulin injection sites to avoid tissue damage.
• B. I will monitor my blood glucose levels before each meal.
• C. I can eat unlimited fruit as it is healthy.
• D. I should carry a fast-acting carbohydrate with me at all times.

Correct answer: C

Rationale: Choice C indicates a need for further teaching because stating 'I can eat unlimited fruit as it is healthy' is incorrect. While fruits are healthy, they also contain natural sugars that can affect blood glucose levels. Portion control is crucial to managing blood glucose levels effectively. Choices A, B, and D demonstrate correct understanding. Rotating insulin injection sites helps prevent tissue damage, monitoring blood glucose levels before meals aids in managing diabetes effectively, and carrying a fast-acting carbohydrate is essential to treat hypoglycemia promptly.

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