Nursing Elites

1. A client with a nasogastric tube requires irrigation once every shift. The client's serum electrolyte results show a potassium level of 4.5 mEq/L and a sodium level of 132 mEq/L. Based on these findings, which solution should the nurse use for nasogastric tube irrigation?

• A. Tap water
• B. Sterile water
• C. Sodium chloride
• D. Normal saline

Correct answer: C

Rationale: The correct solution for nasogastric tube irrigation in this scenario is sodium chloride. The client's low sodium level of 132 mEq/L indicates the need to avoid further imbalance, making sodium chloride the most appropriate choice. Using tap water, which lacks electrolytes, or sterile water could potentially exacerbate the electrolyte imbalance. Normal saline, while similar to sodium chloride, may not be the best choice as it contains a higher concentration of sodium, which could further elevate the client's already borderline sodium level.

2. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

• A. Fluid intake is less than 2,500 ml/day
• B. Urine output measures more than 200 ml/hour
• C. Blood pressure is 90/50 mm Hg
• D. The heart rate is 126 beats/minute

Correct answer: A

Rationale: The correct outcome indicating effective treatment of diabetes insipidus in a male client is a fluid intake of less than 2,500 ml/day. In diabetes insipidus, excessive urination causes increased fluid intake to compensate for the fluid loss. By effectively managing the condition, the client's fluid intake should decrease. Choices B, C, and D do not directly reflect the effectiveness of treatment for diabetes insipidus. Increased urine output (choice B) may indicate inadequate control of the condition, while low blood pressure (choice C) and a high heart rate (choice D) are not specific indicators of effective treatment for diabetes insipidus.

3. When implementing a new policy on the unit, what process should a nurse manager follow?

• A. The nurse manager should involve staff members in the decision-making process, gather input, and communicate the reasons for the policy change to ensure buy-in from the team.
• B. The nurse manager should implement the policy change immediately and monitor staff compliance to ensure that the new policy is being followed.
• C. The nurse manager should delegate the implementation of the policy change to a staff member and provide support as needed to ensure that the change is successful.
• D. The nurse manager should communicate the policy change to staff members, provide training as needed, and monitor the implementation process to ensure that the change is effective.

Correct answer: A

Rationale: When introducing a new policy on the unit, it is essential for the nurse manager to involve staff members in the decision-making process. This approach helps in gathering input and insights from the team, fostering a sense of ownership and commitment. By communicating the reasons behind the policy change, the nurse manager ensures transparency and promotes understanding among the staff, leading to buy-in and acceptance of the new policy. Choice B is incorrect because implementing a policy change without involving staff and explaining the rationale may lead to resistance or lack of understanding. Choice C is not ideal as delegation without active involvement and communication with the team may result in misunderstandings or incomplete implementation. Choice D lacks the crucial step of involving staff in the decision-making process, which is important for successful policy implementation and team engagement.

4. A client at risk for hypokalemia is being instructed by a nurse about foods high in potassium that should be included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that the food item lowest in potassium is:

• A. Apples
• B. Carrots
• C. Spinach
• D. Avocado

Correct answer: A

Rationale: The correct answer is 'Apples.' Apples are the lowest in potassium among the given options. Carrots, spinach, and avocados are all higher in potassium content compared to apples. Carrots and spinach are vegetables known to have a moderate amount of potassium. Avocados, on the other hand, are a high-potassium fruit and would not be the lowest in potassium among the choices provided.

5. Which of the following actions by the healthcare provider would be considered false imprisonment?

• A. The healthcare provider tells the client they are not allowed to leave until the physician has released them.
• B. The healthcare provider asks the client why they wish to leave.
• C. The healthcare provider asks the client to explain what they understand about their medical diagnosis.
• D. The healthcare provider asks the client to sign an against medical advice discharge form.

Correct answer: A

Rationale: The correct answer is A. False imprisonment occurs when a healthcare provider restrains a client from leaving against their will, even if the provider believes it is in the client's best interest. In this scenario, telling the client they are not allowed to leave until the physician has released them constitutes false imprisonment as it restricts the client's freedom of movement. Choice B is incorrect because asking the client why they wish to leave is a form of assessment and does not involve restraining the client. Choice C is incorrect as it pertains to educating the client about their medical condition. Choice D is incorrect because asking the client to sign an against medical advice discharge form is a legal and ethical procedure to ensure the client understands the risks of leaving against medical advice.

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