Nursing Elites

1. A client who is receiving total parenteral nutrition (TPN) has an elevated blood glucose level. Which action should the nurse take first?

• A. Stop the TPN infusion.
• B. Administer insulin as prescribed.
• C. Notify the healthcare provider.
• D. Check the TPN infusion rate.

Correct answer: D

Rationale: The correct first action for a client receiving TPN with an elevated blood glucose level is to check the TPN infusion rate. Elevated blood glucose levels in clients receiving TPN can be due to incorrect infusion rates leading to increased glucose delivery. By checking the TPN infusion rate, the nurse can verify if the rate is appropriate and make necessary adjustments. Stopping the TPN infusion abruptly could lead to complications from sudden nutrient deprivation. Administering insulin as prescribed may be necessary but should come after ensuring the correct TPN infusion rate. Notifying the healthcare provider is important but addressing the immediate need to check the infusion rate takes priority to manage hyperglycemia effectively.

2. After assessing the health care needs of an elementary school, the nurse determines that an increased prevalence of pediculosis capitis is a priority problem. The nurse develops a 2-month program with the goal to eradicate the condition in the school. The program includes educational pamphlets sent home to parents and regular assessment of children by the school nurse. What action should the nurse implement to evaluate the effectiveness of the program?

• A. evaluate the teachers' ability to identify pediculosis capitis 2 months after initiation of the program
• B. conduct an initial examination of each child in the school to obtain baseline data
• C. survey parents 3 weeks after pamphlets are sent home to assess their understanding of the condition
• D. measure the prevalence of pediculosis capitis among the children after four months

Correct answer: D

Rationale: Measuring the prevalence of pediculosis capitis among the children after four months is the most appropriate action to evaluate the program's effectiveness. This approach provides data on the program's long-term impact and effectiveness in eradicating the condition. Option A focuses on the teachers' ability, which is not directly related to the program's effectiveness in eradicating the condition. Option B suggests conducting an initial examination, which does not provide information on the program's impact. Option C involves assessing parents' understanding, which is important but does not directly evaluate the program's effectiveness in eradicating pediculosis capitis.

3. The nurse is preparing to administer a scheduled dose of digoxin (Lanoxin) to a client. Which assessment finding should the nurse report to the healthcare provider?

• A. Heart rate of 90 beats per minute.
• B. Serum potassium level of 4.0 mEq/L.
• C. Blood pressure of 130/80 mm Hg.
• D. Client reports seeing halos around lights.

Correct answer: D

Rationale: Seeing halos around lights is a symptom of digoxin toxicity, which should be reported to the healthcare provider. This visual disturbance is a serious adverse effect of digoxin and indicates potential toxicity. Reporting this finding promptly is crucial to prevent further complications. Choices A, B, and C are within normal limits and do not indicate an immediate need for intervention related to digoxin administration.

4. A public health nurse is evaluating a program designed to reduce the incidence of sexually transmitted infections (STIs) among teenagers. Which outcome indicates that the program is successful?

• A. increased attendance at educational sessions on STIs
• B. higher rates of condom use among teenagers
• C. more teenagers seeking testing for STIs
• D. greater knowledge of STI prevention methods

Correct answer: B

Rationale: The correct answer is B: higher rates of condom use among teenagers. This outcome indicates that the teenagers are adopting safer sexual practices, which can effectively reduce the incidence of STIs. Increased attendance at educational sessions (Choice A) may show interest but does not directly reflect behavior change. More teenagers seeking testing for STIs (Choice C) indicates awareness but not necessarily prevention. Greater knowledge of STI prevention methods (Choice D) is valuable but does not guarantee behavioral change like increased condom use.

5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which finding indicates that the therapy is effective?

• A. The client is able to expectorate secretions easily.
• B. The client's oxygen saturation is 92%.
• C. The client's respiratory rate is 20 breaths per minute.
• D. The client's arterial blood gases show a pH of 7.35.

Correct answer: C

Rationale: In a client with COPD receiving oxygen therapy, an effective response is indicated by a respiratory rate of 20 breaths per minute. This suggests that the client is effectively oxygenating while maintaining an appropriate respiratory rate. Choices A, B, and D are incorrect because expectorating secretions easily, having an oxygen saturation of 92%, and arterial blood gases showing a pH of 7.35 are not specific indicators of the effectiveness of oxygen therapy in COPD. Oxygen saturation of 92% may still be suboptimal in COPD, and arterial blood gases showing a pH of 7.35 may not necessarily reflect the overall effectiveness of oxygen therapy.

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