A nurse is caring for a client who is postoperative and is exhibiting signs of hemorrhagic shock. The nurse notifies the surgeon, who tells the nurse to continue to measure the client's vital signs every 15 min and to report back in 1 hour. Which of the following actions should the nurse take next?

Correct Answer: D

Rationale: The correct answer is D: Notify the nursing manager. The nurse should escalate the situation to the nursing manager because the surgeon's instructions may not be appropriate for a client in hemorrhagic shock. The nurse needs to advocate for the client's safety and ensure prompt and appropriate intervention. Consulting the charge nurse may not be sufficient, and documenting the instructions or completing an incident report does not address the immediate need for proper medical intervention.

Correct Answer: D

Rationale: Staff preferences rank lowest in care objectives patient needs, via plans, holistic views, and standards, take precedence. In Stephanie's hospital, a nurse's shift preference bows to a patient's urgent need, ensuring care aligns with evidence, not whim. Her leadership reinforces this patient-first ethos, critical in a tertiary setting where standards drive quality, guiding new nurses to prioritize clinical over personal considerations for optimal outcomes.

Correct Answer: B

Rationale: A positive FTA-ABS confirms syphilis, not renal infection, lupus, or urethritis. This specific test detects Treponema pallidum antibodies definitive for syphilis, unlike nonspecific infections or autoimmune diseases. Leadership recognizes this imagine rash and fever; it guides penicillin, ensuring cure. This reflects nursing's diagnostic role, aligning with STD management effectively.

Correct Answer: B

Rationale: Heart failure impairs cardiac output, causing fluid retention a key monitoring focus. A weight gain of 1 kg (2.2 lb) in 24 hours signals rapid fluid accumulation roughly 1 L indicating worsening failure or decompensation, requiring provider notification for diuretic adjustment or evaluation. Bounding pulses suggest hyperdynamic states, not typical failure, while dependent edema and fatigue, though common, are expected chronic signs, less urgent unless acute. Rapid weight gain is a red flag per heart failure guidelines, demanding prompt reporting to prevent pulmonary edema or hospitalization, reflecting the nurse's role in early detection and intervention to stabilize the client's fragile condition.

Correct Answer: A

Rationale: The correct answer is A because decision making involves evaluating different options and choosing the best one among them, while problem solving focuses on finding a solution to a specific issue or challenge. Therefore, decision making requires selecting from a set of alternatives, which is not always the case in problem solving. Choice B is incorrect because problem solving may not always involve selecting one of several alternatives; it can also involve finding a creative or innovative solution. Choice C is incorrect because decision making can be part of problem solving when determining the best course of action. Choice D is incorrect because decision making does not always involve solving a problem; it can also involve making choices in various situations.

Correct Answer: B

Rationale: The correct answer is B: Client. In a continuous quality improvement program, the primary focus should be on improving the quality of care and services provided to the clients or patients. This ensures that their needs and preferences are met, resulting in better outcomes. A focus on the family (A) or healthcare providers like nurses (C) and physicians (D) may be important, but the ultimate goal of a quality improvement program is to enhance the client's experience and well-being. By prioritizing the client, the program can address issues directly affecting them and tailor improvements to meet their specific needs.

Correct Answer: C

Rationale: The primary focus of a performance appraisal for nursing staff is to provide feedback on their clinical skills. This is crucial for ensuring quality patient care and professional development. Salary increases (A) are typically based on performance, but not the primary focus. Evaluating overall job performance (B) is important but not as specific as assessing clinical skills. Determining eligibility for promotions (D) may be a part of the appraisal process, but not the primary focus.

Correct Answer: A

Rationale: Assessing needs and problems, per the nursing process, best sets priorities for Henry's patient-focused turnaround. Instructions, control, or ratios follow assessment. In his unit, evaluating a patient's pain or confusion first ensures urgent care trumps routine tasks, aligning resources effectively. This systematic approach planning, organizing, directing mirrors management principles, enabling Henry to lead nurses in addressing critical needs, lifting satisfaction by ensuring care matches patient realities over arbitrary directives.

Correct Answer: D

Rationale: The correct answer is D: Notify the nursing manager. The nurse should escalate the situation to the nursing manager because the surgeon's instructions may not be appropriate for a client in hemorrhagic shock. The nurse needs to advocate for the client's safety and ensure prompt and appropriate intervention. Consulting the charge nurse may not be sufficient, and documenting the instructions or completing an incident report does not address the immediate need for proper medical intervention.