Nursing Elites

1. The nurse is assessing a 17-year-old female client with bulimia. Which of the following laboratory reports would the nurse anticipate?

• A. Increased serum glucose
• B. Decreased albumin
• C. Decreased potassium
• D. Increased sodium retention

Correct answer: C

Rationale: The correct answer is C, 'Decreased potassium.' Clients with bulimia often have decreased potassium levels due to frequent vomiting, which causes a loss of this essential electrolyte. This loss can lead to various complications such as cardiac arrhythmias. Option A, 'Increased serum glucose,' is not typically associated with bulimia. Option B, 'Decreased albumin,' is more related to malnutrition or liver disease rather than bulimia. Option D, 'Increased sodium retention,' is not a common finding in clients with bulimia; instead, they may experience electrolyte imbalances like hyponatremia due to purging behaviors.

2. The mother of a 2 year-old hospitalized child asks the nurse's advice about the child's screaming every time the mother gets ready to leave the hospital room. What is the best response by the nurse?

• A. I think you or your partner needs to stay with the child while in the hospital.
• B. Oh, that behavior will stop in a few days.
• C. Keep in mind that for the age this is a normal response to being in the hospital.
• D. You might want to 'sneak out' of the room once the child falls asleep.

Correct answer: C

Rationale: The nurse should reassure the mother that the child's behavior is normal for their age and situation.

3. A client with limited mobility in his lower extremities is being cared for by a nurse. Which of the following actions should the nurse take to prevent skin breakdown?

• A. Place the client in high-Fowler's position
• B. Increase the client's intake of carbohydrates
• C. Massage the reddened areas with unscented lotion
• D. Have the client use a trapeze bar when changing positions

Correct answer: D

Rationale: The correct answer is to have the client use a trapeze bar when changing positions. This action helps in repositioning without causing friction or shearing, which can lead to skin breakdown. Placing the client in high-Fowler's position (Choice A) may not directly prevent skin breakdown related to limited mobility. Increasing carbohydrate intake (Choice B) is not relevant to preventing skin breakdown. Massaging reddened areas with lotion (Choice C) can potentially cause more harm by increasing friction and damaging the skin further, rather than preventing breakdown.

4. A client is 24 hours postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for “real food.” The nurse tells the client, “I will call the surgeon and ask for a change in diet.” The surgeon hears the nurse’s report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking?

• A. Basic
• B. Commitment
• C. Complex
• D. Integrity

Correct answer: C

Rationale: The nurse demonstrated complex critical thinking by assessing the client's condition, evaluating the need for a change, and making a recommendation to the surgeon. In this scenario, the nurse went beyond simply following instructions or making routine decisions (basic critical thinking). There was a depth of analysis and decision-making involved, showing a higher level of critical thinking than basic or commitment levels. Integrity is about adherence to ethical principles and honesty, not directly related to the critical thinking process.

5. While administering a cleansing enema, the client reports abdominal cramping. Which of the following actions should the nurse take?

• A. Have the client hold their breath briefly and bear down.
• B. Clamp the enema tubing.
• C. Remind the client that cramping is common at this time.
• D. Raise the level of the enema fluid container.

Correct answer: C

Rationale: When a client reports abdominal cramping during a cleansing enema, it is important for the nurse to reassure the client that cramping is a common side effect. This reassurance helps the client understand that the cramping is normal and may subside once the enema is completed. Instructing the client to hold their breath and bear down (Choice A) is not appropriate and may cause discomfort. Clamping the enema tubing (Choice B) is unnecessary and could lead to complications. Raising the level of the enema fluid container (Choice D) does not address the client's discomfort due to cramping. Therefore, the most suitable action is to provide reassurance to the client about the common occurrence of cramping during the enema.

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