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HESI SAUNDERS ONLINE NCLEX (2E) MODULE 5 EXAM LATEST UPDATE
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HESI SAUNDERS ONLINE NCLEX (2E) MODULE 5EXAM LATEST UPDATE
A gentleman who has been visiting his wife at a long-term care facility for clients with
Alzheimer disease suddenly collapses and is taken to the hospital. The client remains
unconscious and testing shows he has cancer which has metastasized to bone, brain,
and liver. The nursing staff at the wife's care facility inform the hospital health care
provider that the client has no other relatives and his wife is mentally incompetent. What
information about do-notresuscitate (DNR) orders does the nurse remember?
a. A DNR order can be written by a client's health care provider
b. If the client stops breathing, everything possible must be done
c. That medications only may be given to the client if the client stops breathing
d. That life support measures will have to be implemented if the client stops breathing -
Answer a. That a DNR order may be written by a client's health care provider
Rationale:
In an event that there are no relatives to give consent to treatment, the professional is
able to give a DNR if reasonably and medically sure that resuscitation would be futile.
The rest of the options are therefore incorrect.
TEST TAKING STRATEGIES:
Focus your attention on the information provided in the question, and identify that the
client has a terminal illness and that there are no relatives except a wife who is mentally
incompetent. Eliminate the similar or sound-alike options that reflect the instillation of
resuscitation measures. Next, eliminate the option that includes the closed-ended word
"only." Review the ethical and legal considerations about DNR orders if you selected an
incorrect answer to this question.
A health care provider continually asks a nurse to write his verbal prescriptions in his
clients' charts after he makes rounds. The nurse is uncomfortable writing the
prescriptions and shares her concern with the health care provider. However, the
,health care provider indicates that the nurse will be reported unless she writes the
prescriptions. How does the nurse resolve this conflict?
Select one:
a. Meeting the request of the health care provider
b. Informing the nurse manager about the situation
c. Informing the chief of medicine at the hospital about the health care provider
d. Telling the health care provider, "I don't really care whether you report me. I am not
writing your prescriptions." - Answer b. Inform the nurse manager about the situation
Rationale:
It is always ideal to handle a conflict directly when one occurs. In this case, the nurse
has tried explaining to the health care provider why she is uncomfortable with the
request, yet she has not been able to resolve the conflict. The nurse would then most
appropriately use the organizational channels of communication and discuss her issue
with the nurse manager, where she then proceeds to resolve the conflict. The nurse
manager might try speaking with the health care provider about the situation, or
telephone the nursing supervisor for assistance. Giving in to the health care provider's
wish and writing the prescriptions in the clients' charts circumvents the problem.
Reporting the health care provider to the chief of medicine is an inappropriate action;
the nurse should follow through the proper organizational channels of communication in
resolving the conflict. This is an inappropriate statement as the response would be "I
don't care whether you report me. I am not writing your prescriptions" and thus will lead
to further conflict between the nurse and health care provider.
TEST TAKING STRATEGIES:
Use knowledge of the subject, conflict management, and the process of elimination.
First eliminate the option that ignores the subject. Eliminate the option that will increase
the conflict between the nurse and the health care provider. To choose between the
remaining options, consider appropriate use of the organizational channels of
communication-this will help you identify the correct option. If you found this question
challenging, re-read the principles of managing conflict.
The nurse is delegating responsibilities for the day. Which of the following should be
delegated by the nurse to the nursing assistant?
Select one:
,a. Suctioning a client who requires intermittent suctioning
b. Performing colostomy irrigation on a client with an ostomy
c. Assisting a client who requires frequent ambulation using a walker
d. Caring for a client who has undergone an arteriogram and requires frequent
monitoring - c. Assisting a client who must ambulate frequently with a walker
Rationale:
The nurse has the responsibility to delegate appropriately nursing care activities for a
client when delegating those tasks to other staff, based on educational level and
competence of the staff. Other noninvasive interventions include ambulating a client
with a walker and can be assigned to a nursing assistant. However, a client who
requires suctioning or one who needs a colostomy irrigation should be assigned to a
licensed nurse because these staff members can perform certain invasive procedures.
The client who has had an arteriogram performed should be delegated to a registered
nurse because these staff have the training and education to identify changes in the
client's condition that need intervention.
TEST TAKING STRATEGIES:
Use the process of elimination, starting with identifying the subject of the question,
delegation to a nursing assistant. Eliminate the similar or alike options that require
invasive treatments. To determine which one of the remaining options is correct,
consider what education a nursing assistant has. The nursing assistant is educated to
walk a client with an assistive device but has not been educated to recognize changes in
a client's condition. If you got this question wrong go back and review the guidelines for
assignment of tasks.
A case manager is reviewing progress notes in a client's medical record. Which notation
indicates the need for follow-up?
PATIENT 1: status postmastectomy 18 hours - five mL of bloody drainage was emptied
from the Jackson-Pratt drain
PATIENT 2: heart failure - crackles were heard in the lower lung lobes bilaterally on
auscultation
PATIENT 3: status postappendectomy 24 hours - The surgical dressing is clean and dry
, CLIENT 4: diabetes mellitus - blood glucose level is 124 mg/dL
a. 1
b. 2
c. 3
d. 4 - Answer b. 2
Rationale:
A case manager role is that of a nurse who accepts accountability for providing care to
the client from the time of admission through and beyond discharge. This nurse may
initiate a plan of care, a care map, or clinical pathway as appropriate for guiding care,
assessing and revising the plan of care appropriately. The case manager monitors the
client for expected and unexpected outcomes and follows up and revises the plan of
care if there is an unexpected outcome noted. Crackles in the lower lobes of the lungs in
a client with heart failure are an unexpected and unwanted outcome requiring follow-up
because they may indicate the development of pulmonary edema. The notations made
for the other clients listed represent expected outcomes.
TEST-TAKING STRATEGY: Consider the role of the case manager and read each
notation closely. Next, focus on the topic, the need for follow-up. This will direct you to
the notation that identifies an unplanned or undesirable event. Crackles, as
bronchovesicular sounds are heard during auscultation, in the lower lobes of the lungs
is a concern. Review the role of the case manager and the expected and unexpected
findings for the client conditions noted in the options if you had difficulty with this
question.
The mission statement of a community hospital is being read by a new nurse. The new
nurse understands that this statement is written for what purpose?
a. To identify benefits provided to employees
b. To document what the organization intends to achieve
c. To identify the policies and procedures of the organization
d. To define the rules of the organization that the employees must follow - Answer b. To
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