Nursing Concepts: Advanced Clinical Application
This section presents advanced nursing concepts through scenario-based questions
designed to test critical thinking and clinical decision-making.
1. Client Attempting Suicide and Leaving Against Medical Advice (AMA):
A nurse is caring for an adult client who has attempted suicide. The client
states their intention to call family for immediate pick-up. When the client
insists on leaving the facility against medical advice, the most appropriate
action by the nurse is to:
o Thoroughly discuss the potential risks and consequences
associated with leaving the facility at this time. This includes the
ongoing safety concerns related to the suicide attempt and the lack of
continued medical and psychological support.
2. Parenteral Nutrition and Suspected Catheter Migration: A client
receiving parenteral nutrition via a nontunneled central venous catheter
reports a gurgling sound on the catheter side. The nurse suspects catheter
migration to the jugular vein. The priority nursing action is to:
o Immediately stop the parenteral nutrition infusion. Further
infusion through a potentially misplaced catheter could lead to serious
complications.
3. Communication Strategies for Aphasia: A nurse is teaching the caregiver
of a client with aphasia. The teaching plan should include the following
communication strategy:
o Cue the client by providing visual aids, such as cards or pictures,
that represent common needs and requests. This nonverbal
, communication method can bypass language deficits and facilitate
understanding.
4. Postoperative Positioning Following Supratentorial Craniotomy (24
hours): The appropriate positioning for a child 24 hours postoperative
following a supratentorial craniotomy is:
o Supine with the head of the bed (HOB) elevated to 30 degrees.
This position promotes venous drainage from the head, reducing
intracranial pressure, while avoiding extreme neck flexion that could
impede circulation.
5. Responding to Distress in Hospice Care: A hospice nurse is speaking with
a client's son who is distressed by his mother's frequent crying and
expressions of wanting to die. An appropriate response by the nurse is:
o "Let's discuss some strategies you can use when this happens
again." This empathetic response acknowledges the son's distress and
offers practical support and coping mechanisms for future
interactions.
6. Teaching a Client at 14 Weeks Gestation: A nurse in a provider's office is
teaching a client who is 14 weeks pregnant. The client should be instructed
to immediately notify the provider if she experiences:
o Facial edema. This can be a sign of preeclampsia, a serious
pregnancy complication characterized by hypertension and
proteinuria, often accompanied by swelling.
7. Expected Outcome of Platelet Transfusion in Leukemia: A child with
leukemia is prescribed a transfusion of platelets. The expected therapeutic
effect of this transfusion is:
This section presents advanced nursing concepts through scenario-based questions
designed to test critical thinking and clinical decision-making.
1. Client Attempting Suicide and Leaving Against Medical Advice (AMA):
A nurse is caring for an adult client who has attempted suicide. The client
states their intention to call family for immediate pick-up. When the client
insists on leaving the facility against medical advice, the most appropriate
action by the nurse is to:
o Thoroughly discuss the potential risks and consequences
associated with leaving the facility at this time. This includes the
ongoing safety concerns related to the suicide attempt and the lack of
continued medical and psychological support.
2. Parenteral Nutrition and Suspected Catheter Migration: A client
receiving parenteral nutrition via a nontunneled central venous catheter
reports a gurgling sound on the catheter side. The nurse suspects catheter
migration to the jugular vein. The priority nursing action is to:
o Immediately stop the parenteral nutrition infusion. Further
infusion through a potentially misplaced catheter could lead to serious
complications.
3. Communication Strategies for Aphasia: A nurse is teaching the caregiver
of a client with aphasia. The teaching plan should include the following
communication strategy:
o Cue the client by providing visual aids, such as cards or pictures,
that represent common needs and requests. This nonverbal
, communication method can bypass language deficits and facilitate
understanding.
4. Postoperative Positioning Following Supratentorial Craniotomy (24
hours): The appropriate positioning for a child 24 hours postoperative
following a supratentorial craniotomy is:
o Supine with the head of the bed (HOB) elevated to 30 degrees.
This position promotes venous drainage from the head, reducing
intracranial pressure, while avoiding extreme neck flexion that could
impede circulation.
5. Responding to Distress in Hospice Care: A hospice nurse is speaking with
a client's son who is distressed by his mother's frequent crying and
expressions of wanting to die. An appropriate response by the nurse is:
o "Let's discuss some strategies you can use when this happens
again." This empathetic response acknowledges the son's distress and
offers practical support and coping mechanisms for future
interactions.
6. Teaching a Client at 14 Weeks Gestation: A nurse in a provider's office is
teaching a client who is 14 weeks pregnant. The client should be instructed
to immediately notify the provider if she experiences:
o Facial edema. This can be a sign of preeclampsia, a serious
pregnancy complication characterized by hypertension and
proteinuria, often accompanied by swelling.
7. Expected Outcome of Platelet Transfusion in Leukemia: A child with
leukemia is prescribed a transfusion of platelets. The expected therapeutic
effect of this transfusion is:
