Nokea
Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be:
- A. Outbreak of Asian flu.
- B. Chemical exposure.
- C. Bacterial pneumonia.
- D. Allergic reaction.
Correct Answer: B
Rationale: The most likely cause of groups of individuals suddenly experiencing similar signs of illness all at once is a chemical exposure. In this scenario, considering the sudden onset of symptoms in multiple passengers on an airliner, the symptoms are more indicative of a chemical exposure rather than Asian flu, bacterial pneumonia, or an allergic reaction. Asian flu, bacterial pneumonia, and allergic reactions do not typically manifest in a way that would affect a group of individuals simultaneously. Therefore, the correct diagnosis in this case is likely to be a chemical exposure.
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A nurse planning care for her assigned clients understands that which aspect is the purpose of the hospital's standards of care?
- A. Identify methods of treatment.
- B. Provide direction for care based on the client's diagnosis.
- C. Identify new care methods based on current medical research.
- D. Provide direction for the practice of nursing
Correct Answer: D
Rationale: The purpose of the hospital's standards of care is to provide a broad direction for the overall practice of nursing that applies to all nursing situations, across specialty areas, and across the country. These standards guide the practice of nursing by outlining the expected level of care and professional performance. While identifying methods of treatment is important, it is usually specific to individual client needs and not the overarching goal of standards of care. Providing direction for care solely based on the client's diagnosis is limited to a particular patient's treatment plan and does not encompass the broader scope of nursing practice. Identifying new care methods based on current medical research is essential for advancing healthcare practices but is not the primary purpose of the hospital's standards of care.
A nurse sees another nurse changing an intravenous (IV) solution because the wrong solution is infusing into the client. The nurse who changed the IV solution does not report the error. What should the nurse who observed the error do first?
- A. Report the nurse who changed the IV solution
- B. Document the error in the client's chart
- C. Call the client's health care provider
- D. Ask the nurse whether she intends to report the error
Correct Answer: D
Rationale: The first thing the nurse who observed the error should do is ask the nurse whether she intends to report the error. Ensuring client safety is paramount, and all errors must be reported to the health care provider, but this is not the initial action. The client should also be assessed immediately. The nurse who discovered the error should complete an incident report and make appropriate documentation in the client's record. If the nurse who observed the error finds out that it will not be reported, it may be necessary to involve the supervisor. Therefore, the best course of action initially is to communicate with the nurse who made the error to understand her intentions regarding reporting.
When ambulating a client with right-sided weakness, a nursing assistant should be positioned on which side of the client?
- A. Stands behind the client
- B. Positions the free hand on the client's shoulder
- C. Stands on the right side of the client
- D. Grasps the security belt in the midspine area of the small of the client's back
Correct Answer: C
Rationale: When ambulating a client with right-sided weakness, the nursing assistant should stand on the affected side, which in this case is the client's right side. This position allows the assistant to provide proper support and assistance. Standing behind the client (Choice A) is incorrect as the assistant should be on the affected side. Positioning the free hand on the client's shoulder (Choice B) is a correct action as it helps in pulling the client toward them in case of a forward fall. Grasping the security belt in the midspine area of the small of the client's back (Choice D) is also correct to provide support and stability during ambulation.
A case manager is reviewing notations made in clients' records. Which note indicates an unexpected outcome and the need for immediate follow-up?
- A. A client who exhibits signs of increased intracranial pressure after a craniotomy.
- B. A client who has sustained a stroke and dresses herself.
- C. A client with a spinal cord injury transfers himself from a bed to a wheelchair.
- D. Normal neurological findings are noted in a client with a cerebral aneurysm.
Correct Answer: A
Rationale: A case manager is responsible for coordinating a client's care and monitoring for unexpected outcomes. The situation that indicates an unexpected outcome and the need for immediate follow-up is when a client exhibits signs of increased intracranial pressure after a craniotomy. This indicates a deteriorating condition that requires urgent intervention. Choices B, C, and D describe expected outcomes or normal findings related to specific conditions, which do not demand immediate follow-up.
A director of nursing at a long-term care center has announced a change to computerized documentation of nursing care. A certified nursing assistant (CNA) on the team, resistant to the change, is not taking an active part in facilitating the implementation of the new procedure. Which strategy would be the best approach to dealing with the conflict?
- A. Meeting with the CNA and encouraging him to express his feelings regarding the change
- B. Ignoring the resistance
- C. Telling the CNA that a licensed practical nurse (LPN) will perform all computer documentation while he documents intake and output and vital signs
- D. Telling the CNA that noncompliance will be documented in the personnel record
Correct Answer: A
Rationale: The best approach to dealing with resistance to change is through open communication and understanding. Meeting with the CNA and encouraging him to express his feelings regarding the change allows for a constructive dialogue where issues can be addressed, and alternative solutions can be explored. Ignoring the resistance does not help in resolving the conflict and may lead to further issues. Telling the CNA that a licensed practical nurse (LPN) will perform all computer documentation while he documents intake and output and vital signs does not address the underlying concerns of the CNA and may create more resistance. Threatening the CNA with noncompliance consequences may escalate the resistance and create a negative work environment.