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. When caring for a client prescribed a blood transfusion that parents refuse due to religious beliefs, what should the nurse do?

• A. Examine personal values about the issue.
• B. Proceed with the transfusion if medically necessary.
• C. Refer the issue to the ethics committee.
• D. Administer the blood transfusion without informing the parents.

Correct answer: A

Rationale: When faced with a situation where parents refuse a prescribed treatment due to religious beliefs, the nurse should first examine personal values, understand the client's or family’s beliefs, and respect their rights. Proceeding with the transfusion against the parents' wishes without exploring alternatives or understanding their perspective would violate the principle of respect for autonomy and could damage the therapeutic relationship. Referring the issue to the ethics committee should be considered if a resolution cannot be reached through open communication and negotiation with the family.

3. The nurse is preparing to administer insulin to a client with type 1 diabetes. Which assessment finding would require the nurse to hold the insulin and contact the healthcare provider?

• A. Blood glucose of 100 mg/dL
• B. Client reports feeling shaky
• C. Client ate only half of breakfast
• D. Client is sweating

Correct answer: A

Rationale: A blood glucose of 100 mg/dL is relatively low for administering insulin, especially if the client has not eaten adequately; further assessment and contacting the provider are necessary. Hypoglycemia can be a serious concern when administering insulin, and a blood glucose level of 100 mg/dL indicates a risk of hypoglycemia. Holding the insulin and contacting the healthcare provider is crucial to prevent hypoglycemia-related complications. Choices B, C, and D are not immediate concerns for holding insulin as they do not directly indicate a risk of hypoglycemic events.

4. A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit, the nurse observes the client smacking her lips alternately with grinding her teeth. The nurse recognizes this assessment finding as what?

• A. Dystonia
• B. Akathisia
• C. Bradykinesia
• D. Tardive dyskinesia

Correct answer: D

Rationale: The correct answer is D: Tardive dyskinesia. Tardive dyskinesia is a potential side effect of long-term antipsychotic use, characterized by involuntary movements like lip smacking and repetitive, purposeless movements. Choice A, dystonia, presents with sustained or repetitive muscle contractions. Choice B, akathisia, involves motor restlessness and a compelling need to be in constant motion. Choice C, bradykinesia, refers to slowness of movement typically seen in Parkinson's disease, not lip smacking and teeth grinding, which are indicative of tardive dyskinesia.

5. When assessing bowel sounds, what action should a healthcare professional take?

• A. Listen to the bowel sounds before performing abdominal palpation
• B. Auscultate for 2 minutes to determine if bowel sounds are present
• C. Place the diaphragm of the stethoscope over each quadrant
• D. Ask the client to cough while auscultating

Correct answer: C

Rationale: When assessing bowel sounds, it is crucial to listen before performing any palpation as palpation can alter bowel sounds. The correct technique involves placing the diaphragm of the stethoscope over each quadrant of the abdomen to listen for bowel sounds. Auscultating for at least 5 minutes is recommended to accurately determine the presence or absence of bowel sounds. Asking the client to cough is not necessary for assessing bowel sounds and may not provide relevant information. Therefore, option C is the correct choice as it follows the appropriate procedure for assessing bowel sounds.

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