Nursing Elites

1. The nurse is performing a physical assessment on a client with insulin-dependent diabetes mellitus. Which client complaint calls for immediate nursing action?

• A. Diaphoresis and shakiness
• B. Reduced sensation in the lower leg
• C. Intense thirst and hunger
• D. Painful hematoma on thigh

Correct answer: A

Rationale: Diaphoresis and shakiness are classic signs of hypoglycemia in a client with insulin-dependent diabetes mellitus. Hypoglycemia is a medical emergency that requires immediate intervention to prevent further complications. The nurse should address this complaint promptly by providing a fast-acting source of glucose to raise the client's blood sugar levels. Reduced sensation in the lower leg may indicate peripheral neuropathy, which is a common complication of diabetes but does not require immediate action unless there are signs of injury. Intense thirst and hunger are symptoms of hyperglycemia, which also requires intervention but not as urgently as hypoglycemia. A painful hematoma on the thigh may require assessment and management, but it is not as urgent as addressing hypoglycemia.

2. After accepting the position of school nurse in a public elementary school, what strategy is best for the nurse to use to obtain an overview understanding of the student body?

• A. Review all health records of the students currently enrolled in classes.
• B. Talk with the current members of the parent-teacher association.
• C. Send a survey form to parents of third-grade students.
• D. Conduct a windshield survey of the geographic areas served by the school.

Correct answer: D

Rationale: Conducting a windshield survey is the best strategy for the nurse to obtain an overview understanding of the student body. This method allows the nurse to observe the community, its resources, potential health hazards, and demographic information. Reviewing health records (Choice A) would provide detailed health information but not an overview of the student body. Talking with the parent-teacher association (Choice B) may offer insights but not a comprehensive overview. Sending a survey form to parents (Choice C) may provide specific information but may not capture a broad understanding of the student body.

3. A client with asthma has low-pitched wheezes present on the final half of exhalation. One hour later the client has high-pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client

• A. Has increased airway obstruction
• B. Has improved airway obstruction
• C. Needs to be suctioned
• D. Exhibits hyperventilation

Correct answer: A

Rationale: The correct answer is A: 'Has increased airway obstruction.' High-pitched wheezes extending throughout exhalation indicate a worsening airway obstruction, leading to increased resistance in the airways. Low-pitched wheezes present on the final half of exhalation may suggest some level of obstruction, but the change to high-pitched wheezes throughout exhalation indicates a progression in the obstruction. Choice B is incorrect as the change in wheeze characteristics signifies deterioration rather than improvement. Choice C is incorrect as suctioning is not indicated based on the wheeze assessment findings. Choice D is incorrect as hyperventilation does not typically present with wheezes and is not supported by the information provided.

4. The following are functions of the Provincial Nurse Supervisor except:

• A. interpreting policies, guidelines, and SDP to nursing and midwifery staff of the province
• B. assessing training needs and planning staff development programs for nursing and midwifery staff
• C. participating in planning, developing, and evaluating OJT for nurses and midwives conducted by the department
• D. collecting, consolidating, analyzing, and interpreting health records and reports and making recommendations as needed

Correct answer: D

Rationale: The correct answer is D. Collecting, consolidating, analyzing, and interpreting health records is not a primary function of a Provincial Nurse Supervisor. The primary functions of a Provincial Nurse Supervisor include interpreting policies, guidelines, and SDP to nursing and midwifery staff, assessing training needs, planning staff development programs, and participating in planning, developing, and evaluating OJT for nurses and midwives. While health records may be accessed for specific purposes, the core responsibilities of a Provincial Nurse Supervisor focus on staff management and development rather than direct involvement in health record analysis.

5. Mark, 9 months old, is given oral rehydration solution because of diarrhea with some dehydration. In your follow-up visit, you observed that Mark's eyes become puffy. Which one of the following would you advise Mark's mother?

• A. continue giving ORS but more slowly
• B. show mother how much solution to give
• C. stop ORS and give plain water or milk
• D. reassess patient to determine how much ORS to give

Correct answer: A

Rationale: In this scenario, observing puffy eyes in a child being treated with oral rehydration solution may indicate fluid overload. Continuing to give ORS but more slowly is the correct course of action as it helps manage hydration without overloading fluids. Choice B is not the best option in this situation as the issue is not about the quantity of the solution, but the rate of administration. Choice C is incorrect because plain water or milk is not a suitable alternative for rehydration in cases of dehydration. Choice D is also incorrect as reassessing the patient does not directly address the issue of puffy eyes, which suggests a need to adjust the administration of ORS.

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