The nurse is assessing a client with suspected hypocalcemia. Which finding supports this diagnosis?

Correct Answer: A

Rationale: In suspected hypocalcemia, muscle cramps support it, not hyperreflexia, moist skin, or fast pulse (hypercalcemia signs). Low calcium causes tetany cramps signal need for replacement. Leadership notes this imagine twitching; it guides treatment, aligning with electrolyte care effectively. This reflects nursing's diagnostic precision.

Correct Answer: C

Rationale: For hypothyroidism, offering high-calorie meals fits, not fluids, cool rooms, or sodium restriction. Low metabolism slows calorie burn, risking weight gain extra calories combat lethargy without overtaxing. Fluids don't target this, coolness worsens cold intolerance, and sodium's unrelated. Leadership includes this imagine a fatigued patient; calories boost energy, enhancing quality of life. This reflects nursing's tailored planning, ensuring nutritional support aligns with endocrine needs, promoting comfort and stability effectively.

Correct Answer: A

Rationale: For peptic ulcer disease, avoiding spicy foods is key, not caffeine, large meals, or alcohol. Spices irritate mucosa caffeine, big meals, and alcohol worsen acid or delay healing. Leadership advises this imagine burning pain; it prevents flares, aligning with GI care effectively. This reflects nursing's dietary focus, ensuring comfort in chronic conditions safely.

Correct Answer: A

Rationale: HIPAA protects client confidentiality, prohibiting discussion of identifiable health information in public areas. Talking about clients in the cafeteria where outsiders could overhear violates this, compromising privacy and risking legal repercussions, warranting a report to the nurse manager for correction. Discussing care in a private meeting is appropriate, as it's confined to involved staff. Charting in the room maintains confidentiality if not exposed to others, and sharing results with the client is their right, not a breach. The cafeteria scenario directly contravenes HIPAA's mandate for secure communication, necessitating intervention to reinforce training and protect client trust, a critical oversight responsibility for the charge nurse.

Correct Answer: B

Rationale: Highlighting shortcomings B is a trap. Nurse leaders fixating on errors, like a missed call, contrast with balanced reflection. In healthcare, this can erode confidence, while awareness should build strengths. It aligns leadership with constructive self-insight, avoiding destructive over-focus.

Correct Answer: B

Rationale: Workplace advocacy supports nurses by equipping them to thrive in a fast-evolving healthcare landscape, addressing challenges like burnout from overtime in the ED. It focuses on career development, rights, and adapting to changes e.g., new protocols or staffing demands rather than direct contract negotiation or dispute representation, which unions handle. Here, the CNO uses advocacy to bolster staff resilience and skills, not to create a practice climate (an outcome, not the mechanism) or act as a bargaining agent. This proactive empowerment helps nurses manage rapid shifts, aligning with advocacy's core purpose of preparing them for dynamic practice settings.

Correct Answer: B

Rationale: Following an amniotomy, the priority assessment is the fetal heart rate because the procedure artificially rupturing the amniotic sac can lead to umbilical cord prolapse, a critical complication where the cord slips below the fetus, compressing it and reducing oxygen supply. Monitoring the fetal heart rate for bradycardia or variability changes immediately detects this risk, allowing swift intervention to protect fetal well-being. Maternal blood pressure, while important, is secondary in this context, as it's less directly affected by amniotomy unless hemorrhage occurs. Uterine contractions increase post-procedure but are expected and not the immediate focus, and fluid output assessment, though relevant, doesn't address the most urgent risk. The nurse's focus on fetal heart rate aligns with the ABC priority framework, emphasizing circulation and oxygenation, ensuring the fetus remains stable after this invasive procedure.

Correct Answer: C

Rationale: Critical listening seeks purpose, unlike attentive, appreciative, or none. Nurse leaders like assessing intent use this, contrasting with surface hearing. In healthcare, it uncovers meaning, aligning leadership with analysis.

Correct Answer: B

Rationale: For spironolactone in HF, monitor potassium, not sodium, calcium, or magnesium. This potassium-sparing diuretic risks hyperkalemia arrhythmias loom if high. Sodium shifts less, others are secondary. Leadership watches this imagine cramps; it guides adjustments, aligning with HF care effectively.