Nursing Elites

1. You are caring for a group of elderly clients, many of whom are affected by multiple chronic disorders and are also, at times, affected by some acute disorders that require medical and nursing attention. As you are caring for these clients, some will need a new medication regimen for an acute disorder. You should consider the fact that the elderly population is at risk for more side effects, adverse drug reactions, and toxicity due to the elderly having a(n):

• A. Increased creatinine clearance.
• B. Impaired immune system.
• C. Decreased hepatic metabolism.
• D. Increased bodily fat

Correct answer: C

Rationale: The correct answer is 'Decreased hepatic metabolism.' The elderly population is at risk for more side effects, adverse drug reactions, and toxicity due to a decrease in hepatic metabolism. This is caused by changes in hepatic functioning in the elderly, including decreased hepatic blood flow and functioning. Choice A, 'Increased creatinine clearance,' is incorrect as aging typically results in decreased, not increased, creatinine clearance. Choice B, 'Impaired immune system,' is not directly related to the increased risk of adverse drug reactions in the elderly. Choice D, 'Increased bodily fat,' is not a primary factor contributing to the increased risk of medication-related issues in the elderly population.

2. At the beginning of the shift, a nurse receives report for her daily assignment. Which of the following situations should the nurse give first priority?

• A. A diabetic client with a blood glucose level of 195 mg/dL
• B. A family member of an elderly client who has questions
• C. A client with COPD with an oxygen saturation of 84%
• D. A client who requires assistance to use the bathroom

Correct answer: C

Rationale: When prioritizing the needs of clients, the nurse must begin with the unstable client or manage conditions that affect airway, breathing, or circulation first. The client with COPD has a condition that affects breathing and is exhibiting decreased oxygen saturation levels; therefore, this client should be the first priority. Option A, the diabetic client with a blood glucose level of 195 mg/dL, does not present an immediate threat to airway, breathing, or circulation. Option B, addressing questions from a family member, is important but can be addressed after addressing critical patient needs. Option D, assisting a client to use the bathroom, is a routine task that can be prioritized after addressing urgent medical needs.

3. A 39-year-old woman presents for treatment of excessive vaginal bleeding after giving birth to twins one week ago. Which nursing diagnosis is most appropriate in this situation?

• A. Knowledge Deficit related to post-partum blood loss
• B. Self-Care Deficit related to post-partum neglect
• C. Fluid Volume Deficit related to post-partum hemorrhage
• D. Body Image Disturbance related to body changes after delivery

Correct answer: C

Rationale: The correct nursing diagnosis in this situation is 'Fluid Volume Deficit related to post-partum hemorrhage.' Post-partum hemorrhage can lead to excessive bleeding, putting the client at risk of fluid volume deficit due to the loss of blood volume. This diagnosis is most appropriate as it addresses the immediate concern of fluid loss. 'Knowledge Deficit related to post-partum blood loss' (Choice A) is incorrect as the priority in this case is addressing the physical issue of fluid volume deficit rather than knowledge deficit. 'Self-Care Deficit related to post-partum neglect' (Choice B) is not relevant to the situation described. 'Body Image Disturbance related to body changes after delivery' (Choice D) is not the most appropriate nursing diagnosis in this context where the primary concern is fluid volume deficit due to post-partum hemorrhage.

4. A client is refusing to undergo any more treatments in the hospital and wants to leave against medical advice. When the nurse requests the client to sign an AMA order, the client refuses and leaves. What is the next action of the nurse?

• A. Call security to hold the client until he signs the order
• B. Notify the physician to convince the client to stay
• C. Speak with the client's spouse to persuade him to stay
• D. Allow the client to leave and document the refusal in his chart

Correct answer: D

Rationale: The nurse cannot force the client to stay in the hospital to receive treatment or to sign an AMA order. It is essential to respect the client's autonomy and decision-making capacity. While involving security or pressuring the client through the physician or spouse may seem like options, they are not appropriate in this situation. The nurse should allow the client to leave if they are competent to make that decision, document the refusal in the client's chart to ensure all actions are appropriately documented, and follow institutional policies for patients leaving against medical advice.

5. If you are caring for a patient of the Hindu culture, what may you anticipate regarding visitors?

• A. Limited visitors, respectful of privacy
• B. Family members only
• C. Large number of visitors/community support
• D. None of the above

Correct answer: C

Rationale: In Hindu culture, there is a strong sense of community and support. It is common for a patient to receive a large number of visitors, indicative of the community coming together to provide emotional and practical support. This support network is crucial for the patient's well-being and healing process. Option A, limited visitors, is incorrect as the Hindu culture values community involvement. Option B, family members only, is incorrect as the support network extends beyond just family. Option D, none of the above, is incorrect as the Hindu culture typically involves community support and a significant number of visitors.

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