Nursing Elites

1. A victim of a gunshot wound to the abdomen has been admitted to the hospital, accompanied by a police officer. When questioned, the officer states that the patient is a suspect in a homicide, which occurred as part of the same incident. A small child was killed as the result of a stray bullet. The patient is combative, yells that he's in pain and demands medication. What is your most appropriate response?

• A. Tell him you'll take care of him after your other patients
• B. Reinforce restraints
• C. Perform a pain assessment and administer pain medication
• D. Ask the officer for more details of the incident

Correct answer: C

Rationale: The most appropriate and caring response is to perform a pain assessment and administer the pain medication that has been ordered. Regardless of personal feelings about any given situation, the nurse's responsibility is to provide unbiased, appropriate, and supportive care, as stated in the American Nurses Association (ANA) Code of Ethics. Choice A is not appropriate as it disregards the patient's immediate need for pain relief. Choice B may escalate the situation and is not the priority in this case. Choice D is not the immediate action needed to address the patient's pain and distress.

2. A client with hyperkalemia may exhibit peaked T waves on an electrocardiogram. This manifestation is an early sign of high potassium levels, but the diagnosis should not be based on this aspect alone. Untreated, hyperkalemia can lead to progressively worsening cardiac instability.

• A. A lumbar puncture takes a sample of cerebrospinal fluid from the back, which will be analyzed by the lab.
• B. The physician will insert a needle at the level of L4-L5 in the spinal cord.
• C. The client should lie flat on their back for a specific period following the procedure.
• D. The risks of the procedure include headache, back pain, and infection.

Correct answer: B

Rationale: A lumbar puncture is performed to obtain cerebrospinal fluid for analysis to investigate various conditions affecting the client. During the procedure, the client is typically positioned on their side or sitting leaning over a table with their back rounded. The physician inserts a needle into the back around the L4-L5 vertebrae to collect the sample. Option A is incorrect because a lumbar puncture does not draw blood but instead collects cerebrospinal fluid. Option C is incorrect as the client should not necessarily lie flat for 24 hours post-procedure. Option D is incorrect as the common risks of a lumbar puncture include headache, back pain, and potential infection, not nausea, rash, or hypotension.

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. Which of these statements best describes the characteristics of an effective reward feedback system?

• A. Specific feedback is given as close to the event as possible
• B. Staff is given feedback in equal amounts over time
• C. Positive statements precede negative statements
• D. Performance goals should be higher than what is attainable

Correct answer: A

Rationale: The correct answer is that specific feedback should be given as close to the event as possible in an effective reward feedback system. This is important because feedback is most useful when provided immediately. Giving feedback promptly reinforces positive behavior and helps in modifying problem behaviors. Providing feedback close to the event helps in ensuring that standards are clearly understood and can be met. Choices B, C, and D are incorrect because staff should not be given feedback in equal amounts over time, positive statements do not necessarily have to precede negative statements, and setting performance goals higher than what is attainable can lead to demotivation and decreased performance.

5. The mother of a 2-month-old infant brings the child to the clinic for a well-baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?

• A. Normally, the testes descend by one year of age.
• B. The infant will likely require surgical intervention.
• C. The infant likely has only one testis.
• D. Normally, the testes are descended by birth.

Correct answer: A

Rationale: The correct answer is that normally, the testes descend by one year of age. In young infants, it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. The exam should be done in a warm room with warm hands. It is most likely that both testes are present and will descend by a year. Option B is incorrect as not all cases of undescended testes require surgical intervention. Option C is incorrect because feeling only one testis does not necessarily mean the infant only has one testis. Option D is inaccurate as the testes do not normally descend by birth, but rather by one year of age. If the testes do not descend by one year, a full assessment will be needed to determine the appropriate treatment.

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