Nursing Elites

1. A 31-year-old client is seeking contraceptive information. Before responding to the client’s questions about contraceptives, the nurse obtains a health history. What factor in the client’s history indicates to the nurse that oral contraceptives are contraindicated?

• A. More than 30 years of age
• B. Had two multiple pregnancies
• C. Smokes 1 pack of cigarettes a day
• D. Has a history of borderline hypertension

Correct answer: C

Rationale: The correct answer is C. Smoking, especially in clients over 30, increases the risk of thromboembolic events, making oral contraceptives contraindicated. Choice A is incorrect as age alone is not a contraindication for oral contraceptives. Choice B is incorrect as having multiple pregnancies is not a contraindication for oral contraceptives. Choice D is incorrect as borderline hypertension is not a strict contraindication for oral contraceptives.

2. One of the reasons hospital patients are at greater risk for drug-nutrient interactions than they used to be is because:

• A. Hospitalized patients are more acutely ill
• B. Hospital routines interfere with the correct timing of medications
• C. Drugs used today are more toxic and have more side effects
• D. Responsibility for monitoring this is shared by various members of the healthcare team

Correct answer: A

Rationale: The correct answer is A. Hospitalized patients are more acutely ill, often having multiple conditions and treatments, which increases the risk of drug-nutrient interactions. Choice B is incorrect because hospital routines do not specifically interfere with the timing of medications in relation to drug-nutrient interactions. Choice C is incorrect because the toxicity and side effects of drugs do not directly relate to an increased risk of drug-nutrient interactions. Choice D is incorrect as sharing responsibility for monitoring does not inherently increase the risk of drug-nutrient interactions in hospital patients.

3. The client has recently been diagnosed with irritable bowel syndrome (IBS). Which intervention should the nurse teach the client to reduce symptoms?

• A. Instruct the client to avoid drinking fluids with meals
• B. Explain the need to decrease intake of flatus-forming foods
• C. Teach the client how to perform gentle perianal care
• D. Encourage the client to see a psychologist

Correct answer: B

Rationale: Choosing option B, explaining the need to decrease intake of flatus-forming foods, is the correct intervention to reduce IBS symptoms. Flatus-forming foods can worsen bloating and discomfort in individuals with IBS. Option A, instructing the client to avoid drinking fluids with meals, may be helpful for other conditions but is not a primary intervention for IBS. Option C, teaching perianal care, is not directly related to reducing IBS symptoms. Option D, encouraging the client to see a psychologist, may be beneficial for managing stress related to IBS but is not the initial intervention to reduce symptoms.

4. Performing and supervising therapeutic and preventive procedures that have been planned for a patient is part of which of the following steps for determining and fulfilling the nursing care needs of the patient?

• A. Evaluation
• B. Planning
• C. Implementation
• D. Assessment

Correct answer: C

Rationale: The correct answer is C: Implementation. In nursing care, implementation involves carrying out and supervising the planned procedures for the patient. This step focuses on putting the care plan into action. Choice A, Evaluation, involves assessing the effectiveness of the care provided, not performing procedures. Choice B, Planning, is about developing a plan of care, not executing it. Choice D, Assessment, is the initial step in the nursing process where data is collected and analyzed to determine the patient's needs, not the step involving performing and supervising procedures.

5. Why may patients with hiatal hernia develop anemia?

• A. Iron absorption is reduced
• B. Gastritis may cause bleeding
• C. Iron stores turn over more quickly
• D. Patients have an aversion to foods that are good sources of iron

Correct answer: B

Rationale: The correct answer is B: Gastritis may cause bleeding. In patients with hiatal hernia, gastritis can occur due to the reflux of stomach acid into the esophagus. This gastritis can lead to gastrointestinal bleeding, resulting in anemia. Choice A is incorrect because iron absorption is not necessarily reduced in hiatal hernia. Choice C is incorrect as iron stores turnover rate is not directly related to the development of anemia in this context. Choice D is incorrect as an aversion to iron-rich foods is not a common reason for anemia in patients with hiatal hernia.

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