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A hospital has achieved Magnet status. Which indicators would be consistent with this type of certification?
- A. There is stratification of communication in a directed manner between nursing staff and administration.
- B. There is increased job satisfaction of nurses, with a lower staff turnover rate.
- C. Physicians are certified in their respective specialty areas.
- D. All nurses have baccalaureate degrees and certification in their clinical specialty area.
Correct Answer: B
Rationale: The correct answer is B. Magnet status focuses on nursing excellence, including job satisfaction and low turnover rates. A is incorrect as it describes hierarchical communication. C is irrelevant to nursing excellence. D is incorrect as while education and certification are important, they are not mandatory for Magnet status.
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Which menopausal discomfort would the nurse anticipate when evaluating a woman for signs and symptoms of the climacteric?
- A. Headaches
- B. Hot flashes
- C. Mood swings
- D. Vaginal dryness with dyspareunia
Correct Answer: B
Rationale: Hot flashes are the most common discomfort caused by fluctuating estrogen levels in perimenopausal women. Other symptoms like headaches or mood swings may occur but are less common.
Which statement by the client indicates that she understands BSE?
- A. I will examine both breasts in two different positions.'
- B. I will examine my breasts 1 week after my menstrual period starts.'
- C. I will examine only the outer upper area of the breast.'
- D. I will use the palm of the hand to perform the examination.'
Correct Answer: B
Rationale: The client should examine her breasts when hormonal influences are at their lowest, ideally 1 week after menstruation.
A nurse is working with an active labor patient who is in preterm labor and has been designated as high risk. The patient is very apprehensive and asks the nurse, “Is everything going to be all right?” The nurse replies, “Yes, everything will be okay.” Following delivery via an emergency cesarean birth, the newborn undergoes resuscitation and does not survive. The patient is distraught over the outcome and blames the nurse for telling her that everything would be okay. Which ethical principle did the nurse violate?
- A. Autonomy N R I G B.C M U S N T O
- B. Fidelity
- C. Beneficence
- D. Accountability
Correct Answer: C
Rationale: The correct answer is C: Beneficence. The nurse violated the ethical principle of beneficence by providing false reassurance to the patient, leading to unrealistic expectations and potential harm. Beneficence is about acting in the best interest of the patient and ensuring their well-being. By misleading the patient, the nurse failed to uphold this principle.
A: Autonomy is the right of the patient to make their own decisions. The nurse did not directly violate the patient's autonomy in this scenario.
B: Fidelity is about being faithful to commitments and promises. The nurse did not violate fidelity, as there was no explicit promise made that was broken.
D: Accountability is about taking responsibility for one's actions. While accountability is important, it is not the primary ethical principle violated in this case.
The nurse is providing care to a 75-year-old female patient diagnosed with osteoporosis. Which of the following would be the priority nursing diagnosis?
- A. At risk for falls related to impaired balance
- B. Knowledge deficit related to new medication regimen
- C. Impaired physical mobility related to pain and skeletal changes
- D. Ineffective health maintenance related to continued immobility
Correct Answer: A
Rationale: The correct answer is A: At risk for falls related to impaired balance. This is the priority nursing diagnosis because falls can lead to serious injury in elderly patients with osteoporosis. Impaired balance is a significant risk factor for falls in this population. Choice B is not the priority as safety takes precedence over knowledge deficit. Choice C may be secondary to the risk of falls. Choice D is not the priority as preventing falls and ensuring patient safety are more critical in this case.
The nurse is writing an expected outcome for the nursing diagnosis—acute pain related to
tissue trauma, secondary to vaginal birth, as evidenced by patient stating pain of 8 on a scale
of 10. Which expected outcome is correctly stated for this problem?
- A. Patient will state that pain is a 2 on a scale of 10.
- B. Patient will have a reduction in pain after administration of the prescribed
- C. Patient will state an absence of pain 1 hour after administration of the prescribed
- D. Patient will state that pain is a 2 on a scale of 10, 1 hour after the administration of
Correct Answer: D
Rationale: The correct answer is D because it aligns with the SMART criteria for expected outcomes. Specific: It clearly states the desired pain level of 2 on a scale of 10. Measurable: It provides a quantifiable measure to assess the outcome. Achievable: The goal is realistic and attainable within a specified time frame. Relevant: It directly addresses the nursing diagnosis of acute pain related to tissue trauma. Time-bound: It includes a timeframe of 1 hour after administration for evaluation.
Choices A, B, and C are incorrect because they do not meet all the SMART criteria. Choice A only focuses on the pain level without a specific timeframe. Choice B mentions pain reduction but lacks a specific target level or timeframe. Choice C mentions pain absence but lacks a specific timeframe for evaluation.