Nursing Elites

1. Which statement by an 8-year-old girl, who was just admitted to the hospital, needs to be explored?

• A. ''Wow! This hospital has bright colors.''
• B. ''Is my mother allowed to visit me tonight?'
• C. ''Those boys are so cute. I hope their room is next to mine!'
• D. ''I'm scared about being here. Can you stay with me awhile?'

Correct answer: C

Rationale: The correct answer is C. An 8-year-old child showing a strong attraction to boys at this age may raise concerns about precocious sexual behavior or exposure to inappropriate sexual content, potentially signaling the need to investigate for possible sexual abuse. It is important to explore this statement further. Choice A, expressing admiration for bright colors, is a common behavior for children of this age and does not raise immediate concerns. Choice B, inquiring about the mother's visit, is a typical concern for a hospitalized child seeking comfort and support. Choice D, expressing fear and seeking reassurance from the nurse, is also a normal reaction for an 8-year-old in a new and possibly intimidating environment. However, the statement in Choice C stands out as it deviates from age-appropriate behavior and warrants further exploration to ensure the child's safety and well-being.

2. A client arrives at an occupational health clinic after being struck by lightning while working in a truck bed. The client is alert but reports feeling faint. Which assessment will the nurse perform first?

• A. Pulse characteristics
• B. Open airway
• C. Entrance and exit wounds
• D. Cervical spine injury

Correct answer: A

Rationale: Assessing pulse characteristics is the priority in this situation due to the potential impact of lightning as a form of electrical current, which can cause irregular heart rhythms. It is crucial to evaluate the pulse rate and regularity to assess for adequate circulation and potential cardiac issues. Since the client is alert and talking, the airway is likely patent, making assessing the airway less urgent. Entrance and exit wounds and cervical spine injury assessments should follow the evaluation of pulse characteristics to ensure proper circulation and prioritize life-threatening issues first. Checking the pulse first will guide further interventions and help in determining the client's hemodynamic status.

3. The healthcare provider is aware that malnutrition is a common problem among clients served by a community health clinic for the homeless. Which laboratory value is the most reliable indicator of chronic protein malnutrition?

• A. Low serum albumin level
• B. Low serum transferrin level
• C. High hemoglobin level
• D. High cholesterol level

Correct answer: A

Rationale: Long-term protein deficiency significantly lowers serum albumin levels. Albumin, derived from protein breakdown, is produced by the liver when adequate amino acids are available. Due to its long half-life, acute protein loss minimally affects serum albumin levels. In contrast, serum transferrin, with a shorter half-life of 8 to 10 days, decreases with acute protein deficiency and is not a reliable indicator of chronic protein malnutrition. Elevated hemoglobin levels may occur in conditions like dehydration or chronic obstructive pulmonary disease, making it an unreliable indicator of chronic protein malnutrition. High cholesterol levels are not directly linked to protein malnutrition and do not serve as a reliable indicator. Therefore, the most reliable indicator of chronic protein malnutrition among the options provided is a low serum albumin level.

4. The client finds a client crying behind a locked bathroom door. The client will not open the door. Which action should the nurse implement first?

• A. Instruct an unlicensed assistive personnel (UAP) to stay and keep talking to the client.
• B. Sit quietly in the client's room until the client leaves the bathroom.
• C. Allow the client to cry alone and leave the client in the bathroom.
• D. Talk to the client and attempt to find out why the client is crying.

Correct answer: D

Rationale: The nurse's first concern should be for the client's safety, so an immediate assessment of the client's situation is needed. Option D is the correct choice as it involves directly addressing the client's emotional state and attempting to understand the reason for the distress. In a vulnerable situation like this, the nurse should take the lead in assessing and communicating with the client. Option A is incorrect as it would delegate the responsibility to someone else when the nurse should be the one to initiate the assessment. Option B is inappropriate as it does not actively address the client's emotional needs or safety. Option C is also incorrect because leaving the client alone without further assessment could potentially endanger the client's well-being.

5. The client has a new colostomy. Which client outcome is most important for achievement of long-range goals associated with adjusting to a new colostomy?

• A. Mastery of colostomy care techniques
• B. Readiness to accept an altered body function
• C. Awareness of community resources available
• D. Understanding necessary dietary modifications

Correct answer: B

Rationale: The most crucial client outcome for successful adjustment to a new colostomy is the readiness to accept an altered body function. Acceptance of changes in body image and function is essential to facilitate mastery of colostomy care techniques and optimal utilization of community resources. Without readiness to accept the altered body function, the client may not be open to learning and adopting necessary changes, hindering the achievement of long-term goals. Understanding dietary modifications, while important, is secondary to the fundamental acceptance of the altered body function in the process of adjusting to a new colostomy.

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