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A patient is transferred to the ICU from the Birth Center of the hospital in the middle of the night after experiencing complications during delivery of her baby. The patients husband is anxious and explains to the ICU nurse that he doesnt understand why his wife has been moved to the ICU. She is going to die, isnt she? he asks the nurse. What is the nurses best response?
- A. Explain that every measure will be taken to provide his wife with the best care possible.
- B. Explain that the nurse is fully trained and has years of experience.
- C. Offer the husband a place to relax.
- D. Have appropriate staff discuss his health insurance with him.
Correct Answer: A
Rationale: The correct answer is A because it addresses the husband's concern directly by assuring him that every measure will be taken to provide the best care for his wife. This response shows empathy and provides reassurance, which is crucial in such a stressful situation. It helps to alleviate the husband's anxiety and fear by emphasizing the hospital's commitment to his wife's well-being.
Explanation for why the other choices are incorrect:
B: This response does not address the husband's immediate concern about his wife's well-being and may come across as dismissive.
C: Offering a place to relax does not address the husband's specific question and does not provide the information he is seeking.
D: Discussing health insurance is not appropriate at this moment of crisis and does not address the husband's fears about his wife's condition.
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The nurse uses subtle measures of painful stimuli, such as nailbed pressure to elicit a response from a neurologically impaired patient. By using this meth od rather than nipple pinching, the nurse is exemplifying what ethical principle?
- A. Beneficence
- B. Fidelity
- C. Nonmaleficence
- D. Veracity
Correct Answer: C
Rationale: The correct answer is C: Nonmaleficence. The nurse is demonstrating nonmaleficence by choosing a less harmful method (nailbed pressure) to assess pain in a neurologically impaired patient, instead of a more painful method (nipple pinching). Nonmaleficence is the ethical principle of avoiding harm or minimizing harm to the patient. In this scenario, the nurse is prioritizing the well-being and comfort of the patient by using a less invasive and painful method to elicit a response. Choices A, B, and D are incorrect because beneficence refers to doing good for the patient, fidelity to being loyal and maintaining trust, and veracity to truthfulness and honesty, none of which directly apply in this situation.
As the nurse admits a patient with end-stage kidney disease to the hospital, the patient tells the nurse, 'If my heart or breathing stops, I do not want to be resuscitated.' Which action is best for the nurse to take?
- A. Ask if these wishes have been discussed with the healthcare provider.
- B. Place a Do Not Resuscitate (DNR) notation in the patient’s care plan.
- C. Inform the patient that a notarized advance directive must be included in the record.
- D. Advise the patient to designate a person to make health care decisions.
Correct Answer: A
Rationale: Step 1: Asking if these wishes have been discussed with the healthcare provider is important to ensure that the patient's wishes are documented and considered in the care plan.
Step 2: The healthcare provider needs to be aware of the patient's preferences regarding resuscitation to provide appropriate care.
Step 3: This step helps in clarifying the patient's preferences and ensures that the healthcare team follows the patient's wishes.
Step 4: Placing a DNR notation without consulting the healthcare provider may not align with the patient's overall care plan and may lead to potential legal and ethical issues.
Step 5: Informing the patient about notarized advance directives and designating a person for healthcare decisions are important but not the immediate step needed in this scenario.
In summary, choice A is correct as it prioritizes communication with the healthcare provider to ensure the patient's wishes are properly documented and followed. Choices B, C, and D are incorrect because they do not involve confirming the patient's wishes
The nurse is caring for four patients on the progressive car e unit. Which patient is at greatest risk for developing delirium?
- A. 36-year-old recovering from a motor vehicle crash with an alcohol withdrawal protocol.
- B. 54-year-old postoperative aortic aneurysm resection with an elevated creatinine level
- C. 86-year-old from nursing home, postoperative from coalboirnb .croemse/tecstti on
- D. 95-year-old with community-acquired pneumonia; fam ily has brought in eyeglasses and hearing aid
Correct Answer: C
Rationale: The correct answer is C, the 86-year-old postoperative from colonic resection. This patient is at the greatest risk for delirium due to being elderly, having undergone surgery, and having a history of being from a nursing home. These factors contribute to an increased susceptibility to delirium.
A: The 36-year-old with alcohol withdrawal may be at risk for delirium tremens, but the older age of the patient in choice C places them at higher risk.
B: The 54-year-old with an elevated creatinine level postoperative is at risk for complications, but age and history of nursing home placement increase the risk for delirium in choice C.
D: The 95-year-old with community-acquired pneumonia is at risk for delirium, but the combination of age, surgery, and nursing home history in choice C presents a greater risk.
Which strategy is important to addressing issues associated with the aging workforce? (Select all that apply.)
- A. Allowing nurses to work flexible shift durations
- B. Encouraging older nurses to transfer to an outpatient se tting that is less stressful
- C. Hiring nurse technicians that are available to assist wit h patient care, such as turning the patient
- D. Developing a staffing model that accurately reflects th e unit’s needs.
Correct Answer: A
Rationale: The correct answer is A: Allowing nurses to work flexible shift durations. This strategy is important in addressing issues associated with the aging workforce because it acknowledges the changing needs and preferences of older nurses. By offering flexible shift durations, older nurses can better manage their work-life balance, reduce physical strain, and continue contributing to the workforce effectively.
Choices B, C, and D are incorrect because they do not directly address the specific needs of the aging workforce. Encouraging older nurses to transfer to a less stressful outpatient setting may not align with their career goals. Hiring nurse technicians to assist with patient care may not address the unique experience and expertise of older nurses. Developing a staffing model, while important, does not specifically cater to the needs of aging nurses in terms of flexibility and support.
The patient has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. These levels most likely indicate
- A. increased nitrogen intake.
- B. acute kidney injury, such as acute tubular necrosis (ATN).
- C. hypovolemia.
- D. fluid resuscitation.
Correct Answer: B
Rationale: The elevated BUN and creatinine levels with a normal BUN/creatinine ratio indicate impaired kidney function. This pattern is commonly seen in acute kidney injury, such as acute tubular necrosis (ATN). In ATN, there is damage to the renal tubules leading to decreased excretion of waste products, resulting in elevated BUN and creatinine levels. The normal BUN/creatinine ratio suggests that the impairment is due to renal tubular dysfunction rather than prerenal causes like hypovolemia or postrenal causes like urinary obstruction. Increased nitrogen intake would not produce this specific pattern of results. Fluid resuscitation would likely result in dilution of BUN and creatinine levels, leading to lower values.