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The nurse instructs a client with a diagnosis of atrial fibrillation who has been prescribed warfarin to use an electric razor for shaving. Which premise best supports the rationale for this instruction?
- A. Cuts need to be avoided.
- B. Any cut may cause infection.
- C. Electric razors can be disinfected.
- D. All straight razors contain bacteria.
Correct Answer: A
Rationale: Clients with atrial fibrillation are placed on anticoagulants to prevent thrombus formation and possible stroke. Therefore, measures to prevent bleeding need to be taught to the client. The importance of use of an electric razor is to prevent cuts and possible bleeding. Not all cuts cause infection. Electric razors can be cleaned but usually cannot be disinfected. Not all straight razors contain bacteria. Additionally, options 2, 3, and 4 are all unrelated to the subject of bleeding; rather, they relate to infection.
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When the nurse manager encourages staff to provide input in the decision-making process, which leadership style is being demonstrated?
- A. Autocratic
- B. Situational
- C. Democratic
- D. Laissez-faire
Correct Answer: C
Rationale: The democratic style of leadership best empowers staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. The autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals. Decisions are made without input from the staff. The situational leadership style uses a style depending on the situation and events. The laissez-faire style allows staff to work without assistance, direction, or supervision.
During the admission process of a client being admitted for surgery, the client asks the nurse if a living will, prepared 3 years ago, remains in effect. Which response is most appropriate for the nurse to provide the client?
- A. Yes, a living will never expires.
- B. You need to speak with an attorney.
- C. I will call someone to answer your question.
- D. If it accurately reflects your situation and wishes.
Correct Answer: D
Rationale: The client should discuss the living will with the primary health care provider (HCP) on a regular basis to ensure that it contains the client's current wishes and desires based on the client's current health status. Option 1 is incorrect. Although the client can consult an attorney if the living will must be changed, the accurate nursing response is to tell the client that a living will should be reviewed. Option 3 is not at all helpful to the client and is, in fact, a communication block and places the client's question on hold.
When teaching a competent postoperative client about a patient-controlled analgesia (PCA) pump, the nurse should include which instructions to the client? Select all that apply.
- A. Report the inability to void.
- B. Report any nausea and vomiting.
- C. Push the button before the pain becomes too great.
- D. Inform the nurse about the pain levels being experienced.
- E. Ask the family to assume management, when the client is sleeping.
Correct Answer: A,B,C,D
Rationale: PCA pumps have opioid medications infusing. Opioids can have an effect on the parasympathetic nervous system causing nausea, vomiting, and an inability to void and defecate; these occurrences need to be reported. The nurse must be kept informed about the pain relief achieved by the client and if there is any breakthrough pain. The client needs to be instructed to push the button before the pain becomes too great. Because the client is competent and there is a basal dose being administered, there is no need for the family to push the buttons for pain relief. In addition, no one other than the client should touch the pump unless instructed to do so.
The nurse working on an adult nursing unit is told to review the client census to determine which clients could be discharged if there are a large number of admissions from a newly declared disaster. The nurse determines that the clients with which medical situations would need to remain hospitalized? Select all that apply.
- A. Laparoscopic cholecystectomy
- B. Fractured hip, pinned 5 days ago
- C. Diabetes mellitus with blood glucose at 180 \mathrm{mg} / \mathrm{dL}(10.2 \mathrm{mmol} / \mathrm{L})
- D. Ongoing ventricular dysrhythmias while receiving procainamide
- E. Newly delivered postpartal client with a blood pressure of 146 / 94mmHg and 2+ proteinuria.
Correct Answer: D,E
Rationale: The client with ongoing ventricular dysrhythmias requires ongoing medical evaluation and treatment because of potentially lethal complications of the problem. The newly delivered postpartal client is showing classic signs for mild preeclampsia. This condition would need to be reversed before discharge. Each of the other problems listed may be managed at home with appropriate agency referrals for home care services and support from the family at home.
A clinical nurse manager conducts an educational session for the staff nurses about case management. Which premise, if stated by one of the staff nurses, regarding case management, should necessitate a need for further teaching?
- A. Manages client care by managing the client care environment
- B. Maximizes hospital revenues while providing for optimal client care
- C. Represents a primary health prevention focus managed by a single case manager
- D. Is designed to promote appropriate use of hospital personnel and material resources
Correct Answer: C
Rationale: Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment and includes assessment and development of a plan of care, coordination of all services, referral, and follow-up.