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An RN’s client with terminal pancreatic cancer asks questions about a do not resuscitate order. Which of the following statements should be included in the RN’s teaching to the client?
- A. When a heart ceases to beat, the client is pronounced clinically dead.
- B. Physicians must write do not resuscitate (DNR) orders.
- C. A DNR order can be written after the health-care provider has discussed it with the client and family.
- D. A DNR requires a court decision.
Correct Answer: C
Rationale: Rationale for Correct Answer C:
1. In terminal cases, it's crucial for the healthcare provider to discuss DNR orders with the client and family to ensure understanding and consent.
2. The decision to implement a DNR order should always involve the client and their family to respect their wishes.
3. This statement emphasizes the importance of communication and shared decision-making in end-of-life care.
Summary:
A: Incorrect - This statement is about the clinical definition of death, not about DNR orders.
B: Incorrect - While physicians can write DNR orders, the involvement of the client and family is essential.
D: Incorrect - DNR orders do not require a court decision; they are typically based on the client's wishes and discussions with healthcare providers.
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1. To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select one that doesn't apply)?
- A. Blood pressure
- B. Serum creatinine
- C. Chest x-ray
- D. Urine for microalbuminuria
Correct Answer: C
Rationale: Step-by-step rationale for correct answer (C):
1. Chest x-ray is not routinely recommended for monitoring complications of type 2 diabetes.
2. Annual blood pressure monitoring is crucial for assessing cardiovascular risk in diabetic patients.
3. Serum creatinine test helps evaluate kidney function, which is often impaired in diabetes.
4. Urine microalbuminuria test detects early signs of kidney damage, common in diabetes.
Summary of incorrect choices:
A: Blood pressure monitoring is essential for assessing cardiovascular risk in diabetes.
B: Serum creatinine test is important for evaluating kidney function in diabetic patients.
D: Urine microalbuminuria test helps detect early kidney damage in diabetes.
The complexities of the current health care delivery systems require a variety of leadership styles. Which of the following leadership styles would be most effective in this environment?
- A. Autocratic leadership
- B. Laissez-faire leadership
- C. Transactional leadership
- D. Transformational leadership
Correct Answer: D
Rationale: The correct answer is D: Transformational leadership. In the current health care environment, transformational leadership is most effective as it focuses on inspiring and motivating individuals to achieve a common goal through innovation and vision. This style encourages creativity, adaptability, and collaboration, which are essential in navigating the complexities of the health care delivery systems. Transformational leaders empower their team members, foster a culture of continuous improvement, and drive positive change. Autocratic leadership (A) is too controlling, Laissez-faire leadership (B) lacks direction and accountability, and Transactional leadership (C) focuses on rewards and punishments rather than inspiring and developing individuals.
A nurse is assessing a client who received an IV fluid bolus for dehydration. Which of the following findings should the nurse identify as an indication of fluid volume excess?
- A. Hypotension
- B. Distended neck veins
- C. Slow capillary refill
- D. Weak, thready pulse
Correct Answer: B
Rationale: The correct answer is B: Distended neck veins. When a client has fluid volume excess, there is an accumulation of fluid in the intravascular space, leading to increased venous pressure. Distended neck veins are a classic sign of fluid overload as they indicate increased central venous pressure. Hypotension (A) is more commonly associated with fluid volume deficit. Slow capillary refill (C) and weak, thready pulse (D) are indicative of poor tissue perfusion, which is more commonly seen in fluid volume deficit rather than excess.
A manager is prioritizing the following issues. Of the following issues, which should be considered urgent and important?
- A. The manager of physical therapy calls and complains about inappropriate behaviors of one of the staff nurses with one of his therapists.
- B. A staff nurse reports a pattern of malfunctioning IV pumps on the unit during her current shift, resulting in overdosing of medications.
- C. One of the staff nurses, who would have been an extra nurse for the next shift, calls in sick.
- D. A small group of staff nurses request a meeting to discuss initiating a scheduling committee.
Correct Answer: B
Rationale: The correct answer is B because it involves patient safety. Malfunctioning IV pumps leading to medication overdosing can result in serious harm to patients. This issue requires immediate attention to prevent any further harm.
A: Inappropriate behaviors, while concerning, do not pose an immediate threat to patient safety.
C: A nurse calling in sick, though inconvenient, can be managed through staffing adjustments and contingency plans.
D: Scheduling committee discussions are important but can be scheduled at a later time without immediate harm to patients.
In order to minimize or avoid negative outcomes as a result of the violation and disciplinary action, the employee should offer which of the following?
- A. Excuses
- B. Discipline
- C. Suggestions
- D. Rules
Correct Answer: C
Rationale: The correct answer is C: Suggestions. When faced with a violation and disciplinary action, offering suggestions demonstrates a proactive approach towards resolving the issue. Suggestions show a willingness to improve and prevent future violations. Excuses (A) are not productive and can come off as deflecting responsibility. Discipline (B) is typically enforced by the employer as a consequence of the violation, not offered by the employee. Rules (D) are guidelines to follow and should already be in place, but offering suggestions on how to adhere to them better is more beneficial.