Nursing Elites

1. The client with cirrhosis of the liver is receiving Lactulose. The nurse is aware that the rationale for the order for Lactulose is:

• A. To lower the blood glucose level
• B. To lower the uric acid level
• C. To lower the ammonia level
• D. To lower the creatinine level

Correct answer: C

Rationale: Lactulose is administered to the client with cirrhosis to lower ammonia levels, as it works by acidifying the colon, trapping ammonia for elimination in the stool. Choices A, B, and D are incorrect because Lactulose does not have an effect on blood glucose, uric acid, or creatinine levels. Therefore, the correct answer is to lower the ammonia level.

2. When the nurse who was not promoted first read the memo and learned that the other nurse had received the promotion, she left the room in tears. This behavior is an example of:

• A. conversion.
• B. regression
• C. introjection.
• D. rationalization

Correct answer: B

Rationale: Crying is a regressive behavior. The ego returned to an earlier, comforting, and less-mature way of behaving in the face of disappointment. Regression involves reverting to an earlier stage of development to cope with stress or conflict. In this scenario, the nurse regressed to a childlike state by crying when faced with the disappointment of not getting the promotion, demonstrating regression as a defense mechanism. Conversion involves transforming anxiety into a physical symptom. Introjection involves unconsciously identifying intensely with another person. Rationalization involves unconsciously creating acceptable explanations to justify unacceptable ideas, actions, or feelings. Therefore, the correct answer is regression as it aligns with the nurse's behavior of regressing to a childlike state by crying due to the disappointment of not receiving the promotion.

3. After talking to the nurse, the charge nurse should:

• A. Report the incident to the Board of Nursing
• B. File a formal reprimand
• C. Terminate the nurse
• D. Charge the nurse with a tort

Correct answer: B

Rationale: The appropriate action after discussing the problem with the nurse is to document the incident and file a formal reprimand. Reporting to the Board of Nursing may be necessary if the behavior persists or harm occurs to the client, but it is not the initial step. Termination should be considered if the issue continues despite warnings. Charging the nurse with a tort is not a suitable course of action in this situation as a tort refers to a wrongful act against a client or their belongings, not an appropriate disciplinary measure. Therefore, choices A, C, and D are incorrect.

4. Which of the following attitudes is essential in a nurse who assists clients during crises?

• A. viewing crisis intervention as the first step in solving bigger problems
• B. wanting to help clients solve all problems identified
• C. taking an active role in guiding the process
• D. feeling that work requires identification with all of a client's problems

Correct answer: A

Rationale: Viewing crisis intervention as the first step in solving bigger problems is essential in a nurse who assists clients during crises. This approach focuses on addressing the immediate crisis first, which can potentially prevent the escalation of bigger problems. Wanting to help clients solve all problems identified (Choice B) may not be feasible or necessary during a crisis situation where immediate intervention is crucial. Taking an active role in guiding the process (Choice C) is important, but the primary focus should be on crisis intervention. Feeling that work requires identification with all of a client's problems (Choice D) may lead to a lack of focus on the immediate crisis at hand.

5. The client is admitted with chronic obstructive pulmonary disease. Blood gases reveal pH 7.36, CO2 45, O2 84, HCO3 28. The nurse would assess the client to be in:

• A. Uncompensated acidosis
• B. Compensated alkalosis
• C. Compensated respiratory acidosis
• D. Uncompensated metabolic acidosis

Correct answer: C

Rationale: The client is experiencing compensated respiratory acidosis. The pH is within the normal range but is lower than 7.40, indicating acidity. The elevated CO2 level and low O2 level suggest respiratory involvement. The slightly elevated HCO3 level indicates a compensatory mechanism. In respiratory acidosis, the pH will be inversely related to the CO2 and bicarb levels, with elevated CO2 and HCO3 levels contributing to acidosis. Choices A, B, and D are incorrect because they do not align with the presented blood gas values and the compensatory response observed in this case.

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