Nursing Elites

1. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse report to the provider?

• A. Blood glucose level of 150 mg/dL
• B. Serum sodium level of 138 mEq/L
• C. Serum potassium level of 3.0 mEq/L
• D. Serum albumin level of 3.8 g/dL

Correct answer: C

Rationale: The correct answer is C. A serum potassium level of 3.0 mEq/L is below the normal range and indicates hypokalemia, which should be reported to the provider. Hypokalemia can lead to serious complications such as cardiac arrhythmias. Choices A, B, and D are within normal ranges and do not require immediate reporting. A blood glucose level of 150 mg/dL is slightly elevated but not critically high. A serum sodium level of 138 mEq/L is within the normal range. A serum albumin level of 3.8 g/dL is also within the normal range.

2. How should a healthcare provider respond to a patient refusing treatment for religious reasons?

• A. Respect the patient's beliefs
• B. Attempt to persuade the patient
• C. Provide education on treatment benefits
• D. Document the refusal and notify the provider

Correct answer: A

Rationale: Respecting the patient's beliefs is crucial in providing patient-centered care. Attempting to persuade the patient may violate their autonomy and decision-making capacity, leading to a breakdown in trust. Providing education on treatment benefits may be appropriate in other situations but is not the best approach when a patient refuses treatment based on religious reasons. Documenting the refusal and notifying the provider are important steps to ensure proper continuity of care, but the primary response should be to respect the patient's beliefs to maintain a trusting relationship and uphold ethical standards.

3. A healthcare provider is providing dietary teaching to a client who has osteoporosis. Which of the following foods should the healthcare provider recommend as the best source of calcium?

• A. Broccoli
• B. Cheddar cheese
• C. Almonds
• D. Fortified orange juice

Correct answer: B

Rationale: Cheddar cheese is a rich source of calcium and should be recommended to clients with osteoporosis. While broccoli and almonds also contain calcium, cheddar cheese provides a higher amount per serving. Fortified orange juice may contain added calcium, but it is not as concentrated a source as cheddar cheese. Therefore, the best choice for a client with osteoporosis seeking a high calcium food is cheddar cheese.

4. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following laboratory values indicates the TPN is effective?

• A. Albumin 3.5 g/dL
• B. Hemoglobin 8 g/dL
• C. WBC count 15,000/mm3
• D. Blood glucose 110 mg/dL

Correct answer: D

Rationale: The correct answer is D. A blood glucose level of 110 mg/dL indicates that the TPN is effective in maintaining normal glucose levels. Hemoglobin level (choice B) is related to anemia and not directly indicative of TPN effectiveness. Albumin level (choice A) is a marker of nutritional status over a longer term and may not reflect immediate TPN effectiveness. White blood cell count (choice C) is related to infection or inflammation and is not a direct indicator of TPN effectiveness.

5. A nurse is administering medications to a group of clients. Which of the following occurrences requires the completion of an incident report?

• A. A client receives antibiotics 2 hours late.
• B. A client vomits within 20 minutes of taking morning medications.
• C. A client requests a statin to be administered at 2100.
• D. A client asks for pain medication 1 hour early.

Correct answer: A

Rationale: The correct answer is A. Administering antibiotics late must be reported as it can compromise the effectiveness of the treatment. This delay can lead to subtherapeutic levels of the antibiotic in the client's system, potentially reducing its efficacy in combating the infection. Choice B, a client vomiting shortly after taking medication, should be noted but does not necessarily require an incident report unless it is a frequent occurrence. It could indicate a possible adverse reaction or intolerance to the medication. Choice C, a client requesting a statin at a specific time, and choice D, a client asking for pain medication slightly earlier, do not involve medication errors or deviations that pose immediate risks to the client's health, so they do not require incident reports.

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