Nursing Elites

1. A school nurse is planning a program to address bullying among students. Which strategy is most likely to be effective?

• A. Implementing a zero-tolerance policy for bullying
• B. Conducting peer mediation sessions
• C. Providing workshops on conflict resolution
• D. Promoting bystander intervention

Correct answer: D

Rationale: Promoting bystander intervention is the most effective strategy as it empowers students to take action and prevent bullying incidents. By encouraging bystanders to intervene when they witness bullying, the behavior is less likely to continue. Zero-tolerance policies may have limited effectiveness as they often focus on punishment rather than prevention. Peer mediation and conflict resolution workshops are valuable but may not directly address the immediate need for bystander intervention in bullying situations.

2. During a follow-up visit, a client with diabetes reports difficulty maintaining a healthy diet. What should the nurse do first?

• A. Provide the client with meal planning resources
• B. Explore the client's dietary habits and challenges
• C. Refer the client to a nutritionist
• D. Educate the client on the importance of a healthy diet

Correct answer: B

Rationale: When a client with diabetes reports difficulty in maintaining a healthy diet, the initial action should be to explore the client's dietary habits and challenges. By doing so, the nurse can identify specific issues and barriers the client faces, which is crucial in developing a personalized and effective intervention plan. Providing meal planning resources (Choice A) can be beneficial later but should come after understanding the client's unique situation. Referring the client to a nutritionist (Choice C) may be necessary in some cases but should follow an assessment of the client's current challenges. Simply educating the client on the importance of a healthy diet (Choice D) does not address the specific difficulties the client is facing and may not lead to sustainable behavior change.

3. While screening all children in the third grade for head lice, the school nurse observes that one girl has a brownish thickening on her neck. Which action should the nurse take in response to this finding?

• A. review the child's medical folder for a list of allergies
• B. instruct the child's parents to begin treatment
• C. advise the child's parents to obtain a medical evaluation of the child
• D. none of the above

Correct answer: C

Rationale: The correct action for the nurse to take is to advise the child's parents to obtain a medical evaluation of the child. This is important because a medical professional needs to properly diagnose and treat the brownish thickening observed on the child's neck. Reviewing the child's medical folder for allergies (Choice A) is not appropriate in this situation as it does not address the specific concern. Instructing the child's parents to begin treatment (Choice B) without a proper diagnosis can be harmful and ineffective. Choosing 'none of the above' (Choice D) is not the best option when a potential health issue is identified; seeking a medical evaluation is the most appropriate course of action.

4. A client with a history of diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which finding requires immediate intervention?

• A. Blood glucose of 200 mg/dL.
• B. Serum bicarbonate of 20 mEq/L.
• C. Blood pressure of 140/90 mm Hg.
• D. Urine output of 50 mL in 4 hours.

Correct answer: D

Rationale: In a client with diabetic ketoacidosis (DKA), urine output of 50 mL in 4 hours indicates oliguria, which is a concerning sign of decreased renal perfusion and potential renal failure. This finding requires immediate intervention to prevent further deterioration of kidney function.\n\nChoice A (Blood glucose of 200 mg/dL) is elevated but not the most urgent concern in this scenario. Choice B (Serum bicarbonate of 20 mEq/L) reflects metabolic acidosis, which is expected in DKA but does not require immediate intervention. Choice C (Blood pressure of 140/90 mm Hg) is slightly elevated but not acutely concerning in the context of DKA.

5. The home health nurse visits a young male client with AIDS who has Kaposi's sarcoma and peripheral neuropathies. His parents, who are the caregivers, tell the nurse that their son sleeps most of the time. The nurse assesses that the client is semi-conscious with stable vital signs, cries out in pain when turned or moved, has a Duragesic pain patch in place, and skin lesions that are closed and dried. Which intervention should the nurse implement?

• A. remove the Duragesic patch as directed by the prescription
• B. give the client a complete bed bath to further assess the client's condition
• C. discuss end-of-life decisions with the client's parents
• D. call for ambulance transportation to the hospital immediately

Correct answer: C

Rationale: In this scenario, the client with AIDS is showing signs of being in a critical condition - semi-conscious, in pain, and with stable vital signs. The appropriate intervention for the nurse to implement is to discuss end-of-life decisions with the client's parents. Given the client's symptoms, the presence of a pain patch, and the closed and dried skin lesions, it is essential to address end-of-life care planning. Removing the Duragesic patch without proper authorization can lead to inadequate pain management and should not be done without consulting the healthcare provider. Giving a complete bed bath is not the priority in this situation as it does not address the immediate needs of the client. Calling for ambulance transportation to the hospital immediately may not be necessary if the client is stable; instead, the focus should be on providing appropriate support and having critical discussions about the client's care preferences.

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