Nursing Elites

1. The parents of a 6-year-old child recently diagnosed with Duchenne muscular dystrophy tell the nurse that their child wants to continue attending swimming classes. How should the nurse respond?

• A. Encourage the parents to allow the child to continue attending swimming lessons with supervision
• B. Suggest that the child be encouraged to participate in a team sport to promote socialization
• C. Explain that their child is not mature enough to understand the risks associated with swimming
• D. Provide a list of alternative activities that are less likely to cause the child to experience fatigue

Correct answer: A

Rationale: Encouraging the parents to allow the child to continue attending swimming lessons with supervision is the most appropriate response. Swimming can be beneficial for the child, providing both exercise and enjoyment. Supervision can help manage any risks associated with swimming. Choice B is incorrect because the child's preference for swimming should be respected, and swimming can still offer socialization opportunities. Choice C is incorrect as it undermines the child's capability to understand the situation. Choice D is less appropriate as it does not address the child's interest in swimming and may limit beneficial physical activity.

2. The healthcare provider believes that a client who frequently requests pain medication may have a substance abuse problem. Which intervention reflects the healthcare provider's value of client autonomy over veracity?

• A. Administer the prescribed analgesic when requested
• B. Refer the client to a substance abuse program
• C. Collaborate with the healthcare provider to provide a placebo
• D. Document the frequency of medication requests

Correct answer: A

Rationale: Administering the prescribed analgesic when requested is the most appropriate intervention that reflects the healthcare provider's value of client autonomy over veracity. This action respects the client's right to manage their pain and avoids deception. Referring the client to a substance abuse program (Choice B) assumes a diagnosis without evidence and does not respect the client's autonomy. Collaborating to provide a placebo (Choice C) would involve deception, which goes against the value of veracity. Documenting the frequency of medication requests (Choice D) is important for the client's care but does not directly address the issue of respecting client autonomy over veracity.

3. Which assessment is most important for the nurse to perform before ambulating a client with a history of syncope?

• A. Pedal pulses
• B. Breath sounds
• C. Oxygen saturation
• D. Blood pressure

Correct answer: D

Rationale: The correct answer is 'D: Blood pressure.' It is crucial to check the client's blood pressure before ambulating them, especially if they have a history of syncope. Monitoring blood pressure helps to prevent falls by ensuring that the client's blood pressure is stable enough to tolerate the activity. Choices A, B, and C are not as critical in this scenario. Checking pedal pulses, breath sounds, or oxygen saturation is important but not as crucial as assessing blood pressure when preparing to ambulate a client with a history of syncope.

4. A nurse working on an endocrine unit should see which client first?

• A. An adolescent male with diabetes who is arguing about his insulin dose.
• B. An older client with Addison’s disease whose current blood sugar level is 62mg/dl (3.44 mmol/l).
• C. An adult with a blood sugar of 384mg/dl (21.31mmol/l) and urine output of 350 ml in the last hour.
• D. A client taking corticosteroids who has become disoriented in the last two hours.

Correct answer: B

Rationale: The correct answer is B. The client with Addison’s disease and a blood sugar level of 62mg/dl (3.44 mmol/l) is experiencing hypoglycemia, which can progress to adrenal crisis. This situation requires immediate attention to prevent further complications. Choices A, C, and D, although concerning, do not pose an immediate life-threatening risk compared to the client with Addison’s disease and hypoglycemia. The adolescent arguing about his insulin dose can be addressed after stabilizing the client with Addison’s disease. The adult with high blood sugar and increased urine output may have hyperglycemia but is not in immediate danger. The client taking corticosteroids who is disoriented needs evaluation but is not in an acute life-threatening condition as the client with hypoglycemia.

5. In what order should the nurse assess a lethargic one-hour-old infant brought to the nursery?

• A. Heel stick
• B. Respirations
• C. Heart rate
• D. Temperature

Correct answer: D

Rationale: When assessing a lethargic one-hour-old infant, the nurse should prioritize assessing the most critical parameters first. Temperature and heart rate are vital signs that provide immediate information about the infant's well-being. Therefore, the correct order of assessment should be temperature, heart rate, respirations, and then a heel stick. Temperature is crucial to determine if the infant is hypothermic or hyperthermic, while heart rate gives insight into the circulatory system's function. Respirations follow to evaluate the infant's breathing pattern. Lastly, the heel stick is important for certain screenings but is not as urgent as evaluating temperature and heart rate in a lethargic infant.

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