Nursing Elites

1. A client with acute pancreatitis is receiving total parenteral nutrition (TPN). The nurse should monitor the client for which of the following complications?

• A. Hypoglycemia
• B. Hyperkalemia
• C. Hyperglycemia
• D. Hyponatremia

Correct answer: C

Rationale: The correct answer is C: Hyperglycemia. Total parenteral nutrition (TPN) contains a high glucose content, which can lead to elevated blood sugar levels, resulting in hyperglycemia. Monitoring for hyperglycemia is crucial in clients receiving TPN to prevent complications such as osmotic diuresis, dehydration, and electrolyte imbalances. Choices A, B, and D are incorrect because TPN is more likely to cause hyperglycemia rather than hypoglycemia, hyperkalemia, or hyponatremia.

2. In planning for the nursing care of the sick person in the home, the major point that the nurse must keep in mind is:

• A. who will be responsible for the patient during the nurse's absence from the home
• B. economic level of the family
• C. the availability of the nearest hospital
• D. whether or not the patient is under a private physician

Correct answer: A

Rationale: The correct answer is A because ensuring someone is responsible for the patient is crucial for continuous care. The presence of a caregiver during the nurse's absence ensures the patient's safety and well-being. Choice B, economic level of the family, is important but not the major point when planning nursing care in the home. Choice C, the availability of the nearest hospital, is significant but doesn't address the day-to-day care in the home. Choice D, whether or not the patient is under a private physician, is relevant but not as critical as ensuring someone is available to care for the patient at all times.

3. A client was re-admitted to the hospital following a recent skull fracture. Which finding requires the nurse's immediate attention?

• A. Lethargy
• B. Agitation
• C. Ataxia
• D. Hearing loss

Correct answer: A

Rationale: Lethargy is a critical finding that requires the nurse's immediate attention when a client with a recent skull fracture is readmitted to the hospital. It can indicate increased intracranial pressure or other serious complications such as hemorrhage or infection. Addressing lethargy promptly is crucial to prevent further deterioration. Agitation, ataxia, and hearing loss are important to assess but do not signify the same level of urgency as lethargy in this context.

4. The social ecological model considers the complex interplay between which levels of influence?

• A. Individual, interpersonal, organizational, community, and policy
• B. Genetic, biological, environmental, social, and economic
• C. Personal, family, community, national, and global
• D. Health, wealth, education, environment, and politics

Correct answer: A

Rationale: The correct answer is A: Individual, interpersonal, organizational, community, and policy. The social ecological model examines how individual, interpersonal, organizational, community, and policy factors interact to influence health and well-being. Choice B is incorrect because it includes genetic and biological factors that are not part of the social ecological model. Choice C is incorrect as it does not include organizational and policy levels of influence. Choice D is incorrect as it includes wealth and politics, which are not typically considered in the social ecological model.

5. In the immediate postoperative period for a cleft lip repair in a 2-month-old infant, which nursing approach should be the priority?

• A. Remove protective arm devices one at a time for short periods with supervision
• B. Initiate oral feedings when alert
• C. Introduce the parents to the suture line cleansing protocol
• D. Position the infant on the back after feedings throughout the day

Correct answer: A

Rationale: The correct nursing approach in the immediate postoperative period for a cleft lip repair in an infant is to remove protective arm devices one at a time for short periods with supervision. This approach helps prevent injury to the surgical site while ensuring the infant's comfort and safety. Choice B is incorrect as initiating oral feedings immediately after surgery may not be appropriate and could compromise the surgical site. Choice C is incorrect as introducing parents to the suture line cleansing protocol is important but not the immediate priority. Choice D is incorrect as positioning the infant on the back after feedings is not specific to the immediate postoperative period for a cleft lip repair.

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