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A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being discharged, this patient will require detailed instructions on how to manage her diet, how to self-inject insulin, and how to handle future diabetic emergencies. Which nurse competency is most needed in this situation?
- A. Clinical judgment
- B. Advocacy and moral agency
- C. Caring practices
- D. Facilitation of learning
Correct Answer: D
Rationale: The correct answer is D: Facilitation of learning. In this scenario, the nurse needs to effectively educate the patient on managing her diet, insulin injections, and handling emergencies. Facilitation of learning involves assessing the patient's learning needs, providing relevant information, demonstrating skills, and evaluating understanding. This competency is crucial for promoting patient education and empowerment in managing their condition.
A: Clinical judgment involves making decisions based on assessment data, which is important but not the primary focus in this situation.
B: Advocacy and moral agency involve standing up for patients' rights and values, which is important but not as directly relevant to the patient's education needs.
C: Caring practices involve showing empathy and compassion, which are essential but not the main competency required for educational purposes in this case.
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The patient’s significant other is terrified by the prospect o f removing life-sustaining treatments from the patient and asks why anyone would do that. What explanation should the nurse provide?
- A. “It is to save you money so you won’t have such a large financial burden.”
- B. “It will preserve limited resources for the hospital so oatbhirebr.c pomat/tieesnt ts may benefit from them.”
- C. “It is to discontinue treatments that are not helping and may be very uncomfortable.”
- D. “We have done all we can for your wife and any more treatment would be futile.”
Correct Answer: C
Rationale: The correct answer is C because it explains that the decision to remove life-sustaining treatments is based on the fact that these treatments are not helping the patient and may actually be causing discomfort. This rationale aligns with the principle of beneficence, which emphasizes doing good and avoiding harm to the patient. It also respects the patient's autonomy by prioritizing their well-being and quality of life.
Choice A is incorrect as it focuses on financial reasons rather than the patient's best interest. Choice B is incorrect because it prioritizes hospital resources over individual patient care. Choice D is incorrect as it lacks clarity and may come across as insensitive to the significant other's concerns.
The charge nurse is responsible for making the patient ass ignments on the critical care unit. She assigns the experienced, certified nurse to care for thea abicrbu.cteomly/t eisltl patient diagnosed with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. She assigns the nurse with less than 1 year of experience to two patients who are more stable. This assignment reflects implementation of what guiding framework?
- A. Crew resource management model
- B. National Patient Safety Goals
- C. Quality and Safety Education for Nurses (QSEN) mod el
- D. Synergy model of practice
Correct Answer: D
Rationale: The correct answer is D: Synergy model of practice. The Synergy model emphasizes matching nurse competencies with patient needs for optimal outcomes. In this scenario, the charge nurse assigned the experienced, certified nurse to a complex patient requiring specialized care (sepsis, renal replacement therapy, ventilation), aligning with the model's principle of matching nurse expertise to patient acuity. Assigning the less experienced nurse to stable patients aligns with the model's focus on optimizing patient outcomes by matching nurse competencies appropriately.
A: Crew resource management model focuses on teamwork and communication to enhance safety, not specifically on nurse-patient assignments.
B: National Patient Safety Goals are broad guidelines for improving patient safety, not specific to nurse-patient assignments.
C: Quality and Safety Education for Nurses (QSEN) model focuses on integrating quality and safety competencies into nursing education, not specifically on nurse-patient assignments.
assessment, the patient is restless, heart rate has increased to 110 beats/min, respirat ions are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sin us tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretio ns. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. In comambirubn.ciocma/tteinstg with the physician, which statement indicates the nurse understands what is likely occurring with the patient?
- A. “May we have an order for cardiac enzymes? This pati ent is exhibiting signs of a myocardial infarction.”
- B. “My assessment indicates potential fluid overload.”
- C. “The patient is having frequent PVCs that are comprom ising the cardiac output.”
- D. “The patient is having a hypertensive crisis; what medications would you like to order?”
Correct Answer: B
Rationale: The correct answer is B: “My assessment indicates potential fluid overload.” The patient is showing signs of fluid overload, such as increased heart rate, respiratory rate, elevated blood pressure, pulmonary artery pressures, frothy secretions, and crackles in lung fields. These symptoms suggest fluid is accumulating in the lungs, causing pulmonary congestion. This can lead to impaired gas exchange and respiratory distress. The nurse's recognition of these signs is crucial for prompt intervention to prevent further complications. Other choices are incorrect because there are no indications of a myocardial infarction, PVCs compromising cardiac output, or a hypertensive crisis based on the given information.
A statement that provides a legally recognized descriptiona obifrb a.cno min/tedsitv idual’s desires regarding care at the end of life is referred to as what?
- A. Advance directive
- B. Guardianship ad item
- C. Healthcare proxy
- D. Power of attorney
Correct Answer: A
Rationale: The correct answer is A: Advance directive. An advance directive is a legal document that outlines a person's wishes regarding medical treatment and care at the end of life. It allows individuals to specify their preferences for medical interventions if they become unable to communicate.
Summary of other choices:
B: Guardianship ad item - This does not specifically pertain to an individual's end-of-life care wishes.
C: Healthcare proxy - While similar to an advance directive, a healthcare proxy specifically designates a person to make medical decisions on behalf of the individual, rather than specifying their own wishes.
D: Power of attorney - This grants someone the authority to make legal decisions on behalf of the individual, but it does not specifically address end-of-life care preferences.
A client who has active tuberculosis (TB) is admitted to the medical unit. What action is most important for the nurse to implement?
- A. Fit the client with a respirator mask.
- B. Assign the client to a negative air-flow room.
- C. Don a clean gown for client care.
- D. Place an isolation cart in the hallway.
Correct Answer: B
Rationale: The correct answer is B: Assign the client to a negative air-flow room. This is crucial to prevent the spread of TB to other patients and healthcare workers. Negative air-flow rooms help contain airborne pathogens. Option A is not sufficient as it only protects the client, not others. Option C is important for infection control but not the priority in this situation. Option D is not as effective as placing the client in a negative air-flow room. Overall, option B is the best choice to ensure the safety of everyone in the unit.