Nursing Elites

1. Which of the following foods should be avoided by clients who are prone to developing heartburn as a result of gastroesophageal reflux disease (GERD)?

• A. lettuce
• B. eggs
• C. chocolate
• D. butterscotch

Correct answer: C: 'chocolate'

Rationale: The correct answer is chocolate. Ingestion of chocolate can reduce lower esophageal sphincter (LES) pressure, leading to reflux and clinical symptoms of GERD. Lettuce and eggs do not significantly affect LES pressure, making them less likely to trigger GERD symptoms. Butterscotch, like lettuce and eggs, does not have a notable effect on LES pressure, so it is not as likely to worsen GERD symptoms as chocolate. Therefore, chocolate is the food to be avoided by clients prone to heartburn due to GERD.

2. A nurse monitoring a client with a chest tube notes that there is no tidaling of fluid in the water seal chamber. After further assessment, the nurse suspects that the client’s lung has reexpanded and notifies the healthcare provider. The healthcare provider verifies with the use of a chest x-ray that the lung has reexpanded, then calls the nurse to ask that the chest tube be removed. Which action should the nurse take first?

• A. Explain the procedure to the client, then remove the chest tube.
• B. Call the nursing supervisor.
• C. Inform the healthcare provider that removal of a chest tube is not a nursing procedure.
• D. Obtain petrolatum-impregnated gauze and ask another nurse to assist in removing the chest tube.

Correct answer: Inform the healthcare provider that removal of a chest tube is not a nursing procedure.

Rationale: The correct action for the nurse to take first is to inform the healthcare provider that removal of a chest tube is not a nursing procedure. Actual removal of a chest tube is the duty of a healthcare provider. If the healthcare provider insists that the nurse remove the tube, the nurse must contact the nursing supervisor. Some agencies’ policies and procedures may permit an advanced practice nurse to remove a chest tube, but there is no information in the question to indicate that the nurse is an advanced practice nurse. Choice A is incorrect because the nurse should not proceed with removing the chest tube without proper authorization. Choice B is incorrect as calling the nursing supervisor should come after clarifying with the healthcare provider. Choice D is incorrect as the nurse should not begin the process of removing the chest tube without proper guidance and authorization.

3. Which of the following statements indicates adequate dietary understanding in a client with constipation?

• A. “I should decrease my intake of fluids.”
• B. “I should decrease my level of activity.”
• C. “I should increase my intake of apples.”
• D. “I should increase my intake of milk.”

Correct answer: “I should increase my intake of apples.”

Rationale: The correct answer is, “I should increase my intake of apples.” This statement indicates adequate dietary understanding in a client with constipation because apples are a good source of fiber, which helps alleviate constipation. Adequate fiber intake is essential for promoting bowel regularity. Choices A and B are incorrect as decreasing fluids and activity level can worsen constipation. Insufficient fluid intake can lead to hard stools, exacerbating constipation. Decreasing activity can also slow down bowel movements. Choice D is incorrect because milk is not a high-fiber food and may not effectively address constipation. While milk can have a mild laxative effect on some individuals, it is not a primary solution for constipation, especially when compared to high-fiber foods like apples.

4. A case manager is reviewing notations made in clients’ records. Which note indicates an unexpected outcome and the need for immediate follow-up?

• A. A client who exhibits signs of increased intracranial pressure after a craniotomy.
• B. A client who has sustained a stroke and dresses herself.
• C. A client with a spinal cord injury transfers himself from a bed to a wheelchair.
• D. Normal neurological findings are noted in a client with a cerebral aneurysm.

Correct answer: A client who exhibits signs of increased intracranial pressure after a craniotomy.

Rationale: A case manager is responsible for coordinating a client's care and monitoring for unexpected outcomes. The situation that indicates an unexpected outcome and the need for immediate follow-up is when a client exhibits signs of increased intracranial pressure after a craniotomy. This indicates a deteriorating condition that requires urgent intervention. Choices B, C, and D describe expected outcomes or normal findings related to specific conditions, which do not demand immediate follow-up.

5. Which of the following scenarios are considered violations of HIPAA laws? Select all that apply.

• A. Discussing discharge plans with a client in a multi-bed recovery room with the curtain drawn around the client’s bed.
• B. Looking up the medical information of a friend not in your care but who gave you permission.
• C. Checking on your spouse’s medical record because you are listed as her power of attorney.
• D. Avoiding conversations about clients while in line in the cafeteria with a mutual caregiver of that client.

Correct answer: B, C

Rationale: Scenarios B and C are considered violations of HIPAA laws. Looking up the medical information of a friend who is not in your care, even with permission, is a violation of HIPAA as the friend is not your patient. Checking on your spouse's medical record, even as a power of attorney, is a violation unless it is directly related to caregiving decisions. Discussing discharge plans with a client in a multi-bed recovery room with the curtain drawn around the client’s bed is not a violation of HIPAA. This scenario is considered an 'incidental disclosure' and is not a breach of HIPAA privacy rules. Avoiding conversations about clients while in line in the cafeteria with a mutual caregiver of that client is actually a good practice as it maintains client confidentiality.

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