Nursing Elites

1. The healthcare provider is caring for a client receiving total parenteral nutrition (TPN). Which laboratory value should be monitored closely to assess for complications?

• A. Serum sodium
• B. Serum calcium
• C. Blood urea nitrogen (BUN)
• D. Blood glucose

Correct answer: D

Rationale: The correct answer is D: Blood glucose. Monitoring blood glucose levels is crucial for clients receiving total parenteral nutrition (TPN) due to the high glucose content in TPN solutions. TPN delivers essential nutrients, including glucose, directly into the bloodstream. Clients on TPN are at risk of developing hyperglycemia due to the concentrated glucose infusion. Therefore, close monitoring of blood glucose levels is necessary to detect and prevent hyperglycemia-related complications such as osmotic diuresis, hyperosmolarity, and electrolyte imbalances. While serum sodium, serum calcium, and blood urea nitrogen (BUN) levels are important parameters in various clinical scenarios, they are not specifically associated with TPN administration. These values are not the primary indicators to assess for complications in clients receiving TPN.

2. When ethical dilemmas arise, what should newly licensed nurses expect and identify as an ethical dilemma?

• A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment.
• B. A nurse overhears another nurse telling an older adult client that if he doesn’t stay in bed, she will have to apply restraints.
• C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill.
• D. A client who is terminally ill hesitates to name their partner on their durable power of attorney form.

Correct answer: C

Rationale: An ethical dilemma involves a situation where there are conflicting values or principles that make it difficult to make a clear decision. In the given scenarios, option C best represents an ethical dilemma as the family has conflicting feelings about initiating enteral tube feedings for their terminally ill father. This situation presents a clash between different values and beliefs, making it challenging to reach a resolution. Options A, B, and D do not illustrate conflicting values or principles that characterize an ethical dilemma. Option A describes a nurse's impairment, which is a concern but not a direct ethical dilemma. Option B depicts a potential breach of client autonomy and restraint use, which is an ethical issue but not a true ethical dilemma. Option D involves a client's personal decision regarding a durable power of attorney form, which, although important, does not present conflicting values or principles that define an ethical dilemma.

3. A nurse is caring for a competent adult client who tells the nurse, 'I am leaving the hospital this morning whether the doctor discharges me or not.' The nurse believes that this is not in the client’s best interest and prepares to administer a PRN sedative medication the client has not requested along with the scheduled morning medication. Which of the following types of tort is the nurse about to commit?

• A. Assault
• B. False imprisonment
• C. Negligence
• D. Breach of confidentiality

Correct answer: B

Rationale: The nurse is about to commit false imprisonment by unlawfully restricting the client's freedom of movement. In this scenario, the nurse's actions of preparing to administer sedative medication against the client's will in an effort to prevent them from leaving the hospital constitute false imprisonment. Assault (choice A) involves the threat of bodily harm, which is not present here. Negligence (choice C) refers to a breach in the duty of care, which is not the primary issue in this situation. Breach of confidentiality (choice D) involves disclosing confidential information without consent, which is unrelated to the scenario described.

4. A 2-year-old child is brought to the health care provider's office with a chief complaint of mild diarrhea for 2 days. Nutritional counseling by the nurse should include which statement?

• A. Place the child on clear liquids and gelatin for 24 hours
• B. Continue with the regular diet and include oral rehydration fluids
• C. Give bananas, apples, rice, and toast as tolerated
• D. Place NPO for 24 hours, then rehydrate with milk and water

Correct answer: B

Rationale: In managing mild diarrhea in a 2-year-old child, it is important to maintain their regular diet and include oral rehydration fluids. Choice A of placing the child on clear liquids and gelatin for 24 hours may not provide adequate nutrition and can lead to further electrolyte imbalances. Choice C of giving bananas, apples, rice, and toast as tolerated is a part of the BRAT diet, which is not recommended as the primary approach anymore due to its limited nutritional value. Choice D of placing the child NPO for 24 hours and then rehydrating with milk and water is not appropriate as it can worsen dehydration and delay recovery. Therefore, the best option is to continue the child's regular diet while incorporating oral rehydration fluids to prevent dehydration and maintain nutritional status.

5. When performing nasotracheal suctioning for a client with a respiratory infection, what technique should the nurse use?

• A. Apply intermittent suction when withdrawing the catheter
• B. Suction continuously while inserting the catheter
• C. Suction intermittently while inserting the catheter
• D. Use a Yankauer suction device

Correct answer: A

Rationale: When performing nasotracheal suctioning for a client with a respiratory infection, the nurse should apply intermittent suction when withdrawing the catheter. This technique helps minimize mucosal damage and is considered best practice. Choice B, suctioning continuously while inserting the catheter, is incorrect as continuous suctioning can cause trauma to the airway. Choice C, suctioning intermittently while inserting the catheter, is also incorrect as it can increase the risk of hypoxia and mucosal damage. Choice D, using a Yankauer suction device, is not appropriate for nasotracheal suctioning as it is typically used for oral suctioning. Therefore, the correct technique is to apply intermittent suction when withdrawing the catheter to ensure effective and safe suctioning.

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