Nursing Elites

1. A client has started sweating profusely due to intense heat. His overall luid volume is low and he has developed electrolyte imbalance. This client is most likely suffering from:

• A. Malignant hyperthermia
• B. Heat exhaustion
• C. Heat stroke
• D. Heat cramps

Correct answer: B

Rationale: Heat exhaustion occurs when a person has enough diaphoresis that he becomes dehydrated. Intense sweating can cause both luid and electrolyte imbalances. Untreated heat exhaustion can lead to heat stroke, which results in organ damage, loss of consciousness, or death.

2. Which of the following interventions should be prioritized in the care of the suicidal client?

• A. Remove all potentially harmful items from the client's room
• B. Allow the client to express feelings of hopelessness
• C. Note the client's capabilities to increase self esteem
• D. Set a "no suicide"? contract with the client

Correct answer: A

Rationale: accessibility of the means of suicide increases the lethality. Allowing a patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients but not specifically for suicide.

3. Becky is a 17-year-old type I diabetic who has been admitted for her third episode of diabetic ketoacidosis (DKA) since being diagnosed last year. She states that she hates feeling different from her friends and refuses to take her insulin as recommended. What would be the most helpful action for Becky?

• A. Scolding her for not taking her insulin
• B. Recommending that she use an insulin pump
• C. Contacting the local support group for diabetic teens
• D. Telling her parents they must provide more strict oversight

Correct answer: C

Rationale: Contacting the local support group for diabetic teens would be the most helpful action for Becky. By reaching out to see if another diabetic teenager could provide support, Becky would have the opportunity to connect with someone in her peer group who faces similar challenges. This connection can help reduce her sense of isolation and the feeling of being 'different.' Choice A, 'Scolding her for not taking her insulin,' is inappropriate and could further alienate Becky. It does not address the underlying emotional issues driving her behavior. Choice B, 'Recommending that she use an insulin pump,' does not directly address Becky's emotional struggle with feeling different from her friends. While an insulin pump may be a helpful tool, it does not tackle the root cause of her non-compliance. Choice D, 'Telling her parents they must provide more strict oversight,' focuses on imposing stricter control without addressing Becky's emotional needs or offering peer support, which may not be effective in improving her insulin adherence in the long term.

4. A group of nurses who work on the quality assurance council of a unit have gathered to discuss ideas about how to educate their coworkers about Joint Commission requirements. Each of the nurses gives ideas, which are listed together without initial criticism. Eventually, all ideas on the list will be discussed as to their validity. This activity is known as:

• A. Optimizing
• B. Satisficing
• C. Brainstorming
• D. Centralizing

Correct answer: C

Rationale: Brainstorming is the process in which group members generate ideas without immediate criticism or evaluation. This allows for a free flow of creative suggestions. The ideas are then listed together for consideration and discussion of their validity at a later stage. Optimizing, although related to improving efficiency, does not specifically address the initial idea generation process. Satisficing refers to accepting a satisfactory or 'good enough' solution rather than seeking the best possible option, which is not reflective of the scenario described. Centralizing typically refers to consolidating decision-making authority rather than the collaborative idea generation process seen in brainstorming.

5. What is involved in obtaining informed consent?

• A. An explanation of the reasons for the procedure
• B. A signature on a form indicating the client agrees to the procedure
• C. A statement affirming liability if complications arise during the procedure
• D. Both A and C

Correct answer: A

Rationale: Informed consent involves providing the client with an explanation of the reasons for the procedure, the potential risks, benefits, and available alternatives. It is essential for the healthcare provider to ensure that the client understands the information provided before agreeing to the procedure. While obtaining a signature on a consent form is part of the process, it is not the sole indicator of informed consent. Option C, which mentions liability statements, is incorrect as informed consent focuses on ensuring the client understands the procedure, not on affirming liability. Therefore, the correct answer is the explanation of the reasons for the procedure.

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