Nursing Elites

1. A family member is complaining that the lights are too dim in the middle of the night when she comes in to visit her husband. What is the most objective response?

• A. Patients sleep better with the lights dimmed.
• B. The nightshift nurses prefer to work with less light.
• C. It's time for him to sleep, and you should, too.
• D. There's a reason we do that. Let me share a research study with you.

Correct answer: D

Rationale: The most objective response in this situation is to explain to the family member that there is a specific reason for dimming the lights and offer to share a research study to provide evidence-based information. By doing so, it helps the family member understand that the care provided is based on established practices and research, potentially alleviating her concerns and ensuring that her husband receives appropriate care. Choices A, B, and C do not address the family member's concern or provide a rationale backed by evidence, making them less suitable responses in this context.

2. Mrs. O is seen for follow-up after an episode of acute pancreatitis. Her physician orders a serum amylase level and the result is 200 U/L. Which of the following is a potential cause of this result?

• A. The client is pregnant
• B. The client has hypertension
• C. The client is in renal failure
• D. The client has pancreatitis

Correct answer: D

Rationale: An elevated serum amylase level after pancreatitis may indicate another attack of the condition. It is common to order serum amylase as part of routine follow-up after pancreatitis. Elevated levels can also be seen in related gastrointestinal conditions like cholecystitis or an intestinal blockage. Therefore, in this case, the most likely cause of the elevated serum amylase level is a recurrence or ongoing pancreatitis. The other options, including pregnancy, hypertension, and renal failure, are not typically associated with an elevated serum amylase level in the context of follow-up after acute pancreatitis.

3. A patient with Addison's disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is not recommended?

• A. A diet high in grains
• B. A diet with adequate caloric intake
• C. A high protein diet
• D. A restricted sodium diet

Correct answer: D

Rationale: For a patient with Addison's disease, a restricted sodium diet is not recommended. These patients require normal dietary sodium to prevent excess fluid loss. Patients with primary adrenal insufficiency (Addison disease) should have ample access to salt because of the salt wasting that occurs if their condition is untreated. Therefore, a diet high in grains, a diet with adequate caloric intake, and a high protein diet are all recommended for patients with Addison's disease to support their nutritional needs and overall health. However, restricting sodium can be detrimental for these patients due to the nature of their condition.

4. Which of the following is an example of whistle-blowing?

• A. A nurse contacts administration about a colleague who takes supplies to use for a mission trip
• B. A client sues a nurse because she failed to call the physician about his wound infection
• C. A nursing assistant calls for help when a client falls out of bed
• D. A client developed a sacral pressure ulcer when he was not turned in bed for over four hours

Correct answer: A

Rationale: Whistle-blowing involves notifying administration or a supervisor about unethical or illegal activities. In this scenario, the nurse reporting a colleague taking supplies for personal use is an example of whistle-blowing as it involves reporting behavior that is dishonest and potentially harmful. Choices B, C, and D do not represent whistle-blowing. Choice B involves a legal action by a client against a nurse, choice C is a situation where immediate care is provided, and choice D is a case of neglect that should have been prevented.

5. Mr. Freeman has difficulty getting out of bed. The nurse should encourage Mr. Freeman to ______________.

• A. ask for assistance before getting out of bed.
• B. remain in bed because it is safer and he will not fall.
• C. instruct him to stand up quickly from the bed.
• D. lean forward and push up and off the bed.

Correct answer: A

Rationale: The nurse should encourage Mr. Freeman to use his call bell and ask for assistance before getting out of bed. This can prevent him from falling. Patients should not stay in bed; they should be encouraged to get out of bed as much as possible to prevent complications like pressure ulcers and muscle weakness. Instructing a patient to stand up quickly from the bed is unsafe as it can lead to dizziness and falls. Similarly, leaning forward and pushing off the bed can increase the risk of falls and should be avoided. Asking for assistance is the safest and most appropriate option to ensure patient safety and prevent accidents.

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