Nokea
A nurse is caring for a client who has an indwelling urinary catheter. Which of the following findings indicates that the catheter requires irrigation?
- A. Urine is positive for ketones
- B. Urine has an unusual odor
- C. Urine specific gravity is 1.035 (normal range: 1.010 to 1.025)
- D. Bladder scan shows 525 mL of urine
Correct Answer: A
Rationale: The correct answer is A because the presence of ketones in the urine may indicate dehydration or infection, which can lead to catheter obstruction. Irrigation may be needed to clear the catheter and prevent further complications. Choices B, C, and D are incorrect because an unusual odor, high specific gravity, and a significant amount of urine in the bladder do not necessarily indicate the need for catheter irrigation.
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A registered nurse (RN) administered a patient’s morning insulin as the breakfast tray arrived at 0800. The RN performed a complete assessment at the same time. Then, the RN got busy with her other patients and did not check on the patient until 1400. At that time, she found the patient unresponsive with a blood glucose of 23. Both the breakfast and lunch tray were at the bedside untouched. Which of the following could the RN be charged with?
- A. Quasi-intentional tort
- B. Misdemeanor
- C. Negligence
- D. Juvenile offense
Correct Answer: C
Rationale: The correct answer is C: Negligence. Negligence involves a breach of duty of care that results in harm or injury to another person. In this scenario, the RN failed to check on the patient for several hours despite administering insulin and knowing the patient's condition. This failure to provide proper monitoring and care directly led to the patient becoming unresponsive with critically low blood glucose levels.
Choice A, quasi-intentional tort, involves intentional actions that result in harm, which is not applicable in this scenario. Choice B, misdemeanor, refers to a criminal offense of a lesser degree, not a charge that would typically apply to this situation. Choice D, juvenile offense, is not relevant as the RN's actions are not related to the age of the individual involved.
A nurse is caring for a client who has diarrhea due to shigella. Which of the following precautions should the nurse implement for this client?
- A. Have the client wear a mask when receiving visitors.
- B. Limit the client's time with visitors to no more than 30 minutes per day.
- C. Assign the client to a room with negative-pressure airflow exchange.
- D. Wear a gown when caring for the client.
Correct Answer: B
Rationale: The correct answer is B: Limit the client's time with visitors to no more than 30 minutes per day. This is the correct precaution because shigella is transmitted through fecal-oral route. By limiting the client's time with visitors, the risk of spreading the infection to others is minimized.
Explanation for why other choices are incorrect:
A: Having the client wear a mask when receiving visitors is not necessary for preventing the spread of shigella, as it is not transmitted through the air.
C: Assigning the client to a room with negative-pressure airflow exchange is more suitable for airborne infections, not for shigella which is transmitted through fecal-oral route.
D: While wearing a gown when caring for the client is a good infection control practice, it is not specifically indicated for preventing the spread of shigella through contact with visitors.
Which of the following is true regarding health care systems today?
- A. They are all managed care organizations.
- B. They are all privately owned.
- C. Only HMOs are profitable.
- D. There are multiple types of organizations.
Correct Answer: D
Rationale: The correct answer is D because there are indeed multiple types of health care organizations today, including but not limited to managed care organizations, private entities, non-profit organizations, and government-funded systems. This diversity in health care systems allows for different models and approaches to delivering care, catering to the needs and preferences of various populations. Choices A, B, and C are incorrect because not all health care systems are managed care organizations, privately owned, or solely profitable for HMOs. It is essential to understand the complexity and variety in health care systems to provide comprehensive and efficient care to patients.
Which of the following is a characteristic of a well-written goal?
- A. Goals should be vague
- B. Goals should be unrealistic
- C. Goals need to be measurable, realistic, and achievable
- D. Goals should be easy to achieve
Correct Answer: C
Rationale: The correct answer is C because well-written goals need to be specific, measurable, achievable, relevant, and time-bound (SMART). Measurable goals allow for tracking progress, realistic goals are attainable, and achievable goals are within reach. Vague goals (A) lack clarity, unrealistic goals (B) may lead to frustration, and goals that are too easy to achieve (D) do not challenge individuals to grow and improve. Therefore, option C is the best choice for a well-written goal.
A nurse manager is interested in solving a serious conflict that exists among the nursing staff. He uses a strategy that involves allowing the group to explore a number of solutions and come to a consensus on a solution. What strategy for conflict resolution has the manager used?
- A. Integrative decision-making
- B. Win-win
- C. Competing
- D. Confrontation
Correct Answer: A
Rationale: The correct answer is A: Integrative decision-making. This strategy involves allowing the group to explore multiple solutions and reach a consensus, fostering collaboration and mutual benefit. This approach promotes a win-win outcome and encourages open communication and respect among team members. It is effective for resolving conflicts as it focuses on finding a solution that satisfies the interests of all parties involved.
Choice B: Win-win is a similar concept to integrative decision-making but lacks the emphasis on exploring multiple solutions and reaching a consensus.
Choice C: Competing involves one party winning at the expense of the other, contrary to the collaborative nature of integrative decision-making.
Choice D: Confrontation is a direct and aggressive approach that does not promote collaboration or consensus-building like integrative decision-making does.