Giddens, Jean F. Concepts for Nursing Practice Study Guide

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Sample questions from Giddens, Jean F. Concepts for Nursing Practice Study Guide

This material has 24 questions with answers and rationales. Here are the first 5.

1. 1.An alert adult with decision-making capacity declines a recommended blood transfusion because of religious beliefs. The patient can explain the risks of refusing treatment. Which action best demonstrates person-centered care and legal accountability?

   • A.Ask a family member to sign consent because the transfusion could prevent serious harm.
   • B.Respect the refusal, notify the prescribing clinician, discuss acceptable alternatives, and document the discussion.
   • C.Delay documenting the refusal until the patient has another opportunity to accept treatment.
   • D.Explain that the health care team may administer the transfusion because preserving life overrides refusal.

   Rationale: A patient with decision-making capacity may refuse treatment after receiving relevant information. Respecting the refusal, exploring alternatives, notifying the clinician, and documenting support autonomy and safe care. Family consent cannot override this patient's decision. Delaying documentation impairs communication and accountability. Potential benefit does not authorize overriding an informed refusal.

2. 2.During a routine visit, an older adult reports two falls in the past month and difficulty getting out of a chair. The patient takes several prescription medications and lives alone. Which nursing action is most appropriate initially?

   • A.Recommend avoiding exercise until the patient has remained free of falls for six months.
   • B.Explain that recurrent falls are an expected consequence of aging.
   • C.Arrange permanent assisted living placement based on the reported falls.
   • D.Assess gait, balance, orthostatic blood pressure, medication use, and ability to perform daily activities.

   Rationale: A focused assessment identifies reversible fall risks and functional needs before an individualized plan is developed. Prolonged exercise avoidance can worsen weakness and balance. Falls are not an inevitable or normal consequence of aging. Permanent placement is premature without assessing function, available supports, and the patient's preferences.

3. 3.An adult hospitalized with pneumonia suddenly becomes restless. Respiratory rate is 32/min, oxygen saturation is 84% on room air, and blood pressure is 88/54 mm Hg. Which action should the registered nurse take first?

   • A.Remain with the patient, initiate oxygen per emergency protocol, and activate the rapid response team.
   • B.Delegate repeat vital signs to assistive personnel and assess the patient after completing scheduled medications.
   • C.Document the findings and request a routine clinician evaluation during rounds.
   • D.Assist the patient to walk to a chair to improve lung expansion.

   Rationale: New restlessness, severe hypoxemia, tachypnea, and hypotension indicate acute deterioration requiring immediate oxygenation support and emergency assistance. Delegating repeat measurements while delaying assessment is unsafe; the registered nurse must manage the unstable patient. Routine documentation and rounds do not address the urgency. Ambulation increases oxygen demand and creates a fall risk in a hypotensive patient.

4. 4.At a discharge teaching visit, a patient with heart failure reports taking newly prescribed spironolactone along with an old potassium supplement. Laboratory results show potassium of 5.8 mEq/L. Which nursing action is the priority?

   • A.Encourage potassium-rich foods because all diuretics increase potassium loss.
   • B.Reassure the patient that this potassium level is expected during heart failure treatment.
   • C.Promptly notify the prescriber, assess for cardiac symptoms, and clarify both medications before further doses.
   • D.Recommend taking the potassium supplement at a different time from spironolactone.

   Answer and rationale are in the full material.

5. 5.A hospitalized patient with type 1 diabetes is awake, can swallow safely, and reports shaking and sweating. Capillary blood glucose is 54 mg/dL. Which intervention is most appropriate?

   • A.Administer the scheduled rapid-acting insulin and then provide a meal.
   • B.Give 15 g of rapid-acting carbohydrate and recheck blood glucose in 15 minutes.
   • C.Offer a high-fat snack and repeat the glucose measurement in one hour.
   • D.Withhold oral intake and wait for a laboratory glucose result before treating.

   Answer and rationale are in the full material.