Nursing Elites

1. The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action should the nurse take next?

• A. Monitor ionized calcium level.
• B. Give oral calcium citrate tablets.
• C. Check parathyroid hormone level.
• D. Administer vitamin D supplements.

Correct answer: A

Rationale: This patient with chronic malnutrition is likely to have a low serum albumin level, which will affect the total serum calcium. A more accurate reflection of calcium balance is the ionized calcium level. Most of the calcium in the blood is bound to protein (primarily albumin). Alterations in serum albumin levels affect the interpretation of total calcium levels. Low albumin levels result in a drop in the total calcium level, although the level of ionized calcium is not affected. The nurse should monitor the ionized calcium level to get a clearer picture of the patient's calcium status. Giving oral calcium citrate tablets, checking parathyroid hormone level, or administering vitamin D supplements may be necessary based on the ionized calcium results, but they are not the immediate next step in assessment and management.

2. An older patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the health care provider immediately?

• A. K+ 3.4 mEq/L (3.4 mmol/L)
• B. Ca+2 7.8 mg/dL (1.95 mmol/L)
• C. Na+ 154 mEq/L (154 mmol/L)
• D. PO4-3 4.8 mg/dL (1.55 mmol/L)

Correct answer: C

Rationale: The correct answer is C. The elevated serum sodium level (154 mEq/L) is consistent with the patient's neurologic symptoms of restlessness, agitation, and weakness, indicating a need for immediate action to prevent complications like seizures. The potassium level (3.4 mEq/L) and calcium level (7.8 mg/dL) are slightly off from normal but do not require immediate action. The phosphate level (4.8 mg/dL) is normal and not related to the symptoms presented by the patient.

3. The nurse in the emergency department observes a colleague viewing the electronic health record (EHR) of a client who holds an elected position in the community. The client is not a part of the colleague's assignment. Which action should the nurse implement?

• A. Communicate the colleague's actions to the unit charge nurse
• B. Send an email to facility administration reporting the action
• C. Write an anonymous complaint to a professional website
• D. Post a comment about the action on a staff discussion board

Correct answer: A

Rationale: Viewing the EHR of a client who is not under your care is a violation of HIPAA regulations, regardless of the client's social status or your curiosity. The appropriate action to take in this situation is to communicate the colleague's actions to the unit charge nurse. The charge nurse can then escalate the issue through the appropriate channels within the organization. Reporting to the charge nurse ensures that the incident is handled internally and in accordance with organizational policies and procedures. Sending an email to facility administration, writing an anonymous complaint to a professional website, or posting a comment on a staff discussion board are not the recommended actions as they may not address the issue effectively and could potentially violate confidentiality further.

4. The home health nurse cares for an alert and oriented older adult patient with a history of dehydration. Which instructions should the nurse give to this patient related to fluid intake?

• A. Increase fluids if your mouth feels dry.
• B. More fluids are needed if you feel thirsty.
• C. Drink more fluids in the late evening hours.
• D. If you feel lethargic or confused, you need more to drink.

Correct answer: A

Rationale: The correct answer is A. An alert, older patient can self-assess for signs of dehydration like dry mouth. This instruction is appropriate as it encourages the patient to respond to early signs of dehydration. Choice B is incorrect because the thirst mechanism decreases with age and feeling thirsty may not accurately indicate the need for fluids. Choice C is incorrect as many older patients prefer to limit evening fluid intake to enhance sleep quality. Choice D is incorrect because an older adult who is lethargic or confused may not be able to accurately assess their need for fluids.

5. Before leaving the room of a confused client, the nurse notes that a half bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed frame. What action should the nurse take before leaving the room?

• A. Tie the knot with a double turn or square knot
• B. Ensure that the restraints are snug against the client's wrists
• C. Ensure that the knot can be quickly released
• D. Move the ties so the restraints are secured to the side rails

Correct answer: C

Rationale: The priority is to ensure that the knot can be quickly released to allow for quick intervention if necessary. Tying the knot with a double turn or square knot (Choice A) may make it more difficult to release quickly in an emergency. Ensuring that the restraints are snug against the client's wrists (Choice B) may compromise circulation and cause discomfort. Moving the ties to secure the restraints to the side rails (Choice D) is not the appropriate action as it can limit the client's movement and access to care.

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