The nurse is talking with the parent of an adolescent client with suspected bulimia nervosa. Which of the following statements by the client's parent would be consistent with bulimia nervosa?
- A. I have noticed my child cuts food into small pieces and pushes it around the plate.
- B. I found several empty boxes of laxatives in my child's bedroom.
- C. My child has lost 20 lb (9.1 kg) in the past 2 months.
- D. My child has stopped exercising.
Correct Answer: B
Rationale: Laxative abuse is a common purging behavior in bulimia nervosa. Cutting food and pushing it around is more typical of anorexia. Significant weight loss is less common in bulimia, as weight often fluctuates. Reduced exercise isn't characteristic.
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A 12-month-old client has a high blood lead level of 18 mcg/dL. The nurse is reinforcing teaching about lead poisoning to the parents. Which statements made by a parent indicate that teaching has been successful? Select all that apply.
- A. I should have our home inspected for the source of lead.
- B. I will vacuum our hard-surface floors daily.
- C. I will wash my child's hands often, especially before eating.
- D. We should use hot water from the tap for cooking.
- E. We will have to return for a follow-up lead level.
Correct Answer: A,C,E
Rationale: Inspecting the home identifies lead sources (e.g., paint, dust). Frequent hand washing reduces ingestion of lead dust. Follow-up testing monitors levels. Vacuuming may spread lead dust; wet mopping is preferred. Hot water can leach lead from pipes; cold water is safer.
The practical nurse is assisting the registered nurse in creating a care plan for a client who is intubated, on mechanical ventilation, and receiving continuous enteral tube feedings via a small-bore nasogastric tube. Which interventions should be included to prevent aspiration in this client? Select all that apply.
- A. Check gastric residual every 12 hours
- B. Keep head of the bed at ≥30 degrees
- C. Maintain endotracheal cuff pressure
- D. Monitor for abdominal distension every 4 hours
- E. Use caution when administering sedatives
Correct Answer: B,C,D,E
Rationale: Elevating the head of the bed (≥30 degrees) reduces reflux, proper cuff pressure seals the airway, monitoring distension detects feed intolerance, and cautious sedation prevents respiratory depression. Residual checks every 4-6 hours are standard, not 12.
The nurse's neighbor has a total cholesterol of 450 mg/dL. The neighbor asks the nurse what this means. What should the nurse include when responding?
- A. The cholesterol level is slightly high, but exercise and a low-fat diet should reduce it to normal.
- B. The cholesterol level is below normal levels, but this is good.
- C. The cholesterol level is high. The neighbor should talk with the physician about ways to lower it.
- D. The cholesterol is within normal limits.
Correct Answer: C
Rationale: A cholesterol level of 450 mg/dL is significantly elevated, increasing cardiovascular risk, requiring medical consultation.
Clients taking lithium must be particularly sure to maintain adequate intake of which of these elements?
- A. Potassium
- B. Sodium
- C. Chloride
- D. Calcium
Correct Answer: B
Rationale: Clients taking lithium need to maintain an adequate intake of sodium. Serum lithium concentrations may increase in the presence of conditions that cause sodium loss.
The nurse is talking with the spouse of a client who is eligible for hospice care. The spouse states, 'I do not know if I can make this decision. What would you do?' Which of the following responses would be appropriate for the nurse to make?
- A. These decisions are challenging. Tell me about your spouse's beliefs regarding end-of-life care.
- B. You seem overwhelmed. I will ask the chaplain to speak with you about available options.
- C. I find it helpful to investigate all options. I will get you a pamphlet about hospice services.
- D. I had to make a similar decision when my spouse was ill. Do what feels best for you.
Correct Answer: A
Rationale: The nurse should remain neutral and facilitate discussion about the client's values and preferences, helping the spouse make an informed decision without personal bias or directing to other resources prematurely.