Nursing Elites

1. A client with gastroesophageal reflux disease (GERD) reports frequent heartburn. What dietary modification should the nurse recommend?

• A. Avoid eating large meals late at night.
• B. Eat a high-fat diet to buffer stomach acid.
• C. Reduce fluid intake to prevent acid reflux.
• D. Consume spicy foods to neutralize stomach acid.

Correct answer: A

Rationale: The correct answer is to recommend avoiding eating large meals late at night. This dietary modification can help reduce the risk of acid reflux, which can exacerbate GERD symptoms. Consuming smaller, more frequent meals is generally recommended to minimize pressure on the lower esophageal sphincter. Choice B is incorrect because a high-fat diet can worsen GERD symptoms by delaying stomach emptying. Choice C is incorrect because reducing fluid intake can lead to dehydration and will not prevent acid reflux. Choice D is incorrect because spicy foods can actually trigger or worsen acid reflux symptoms in individuals with GERD.

2. A client receiving full-strength continuous enteral tube feeding develops diarrhea. What intervention should the nurse take?

• A. Stop the feeding and provide IV fluids.
• B. Dilute the feeding to half strength and continue at the same rate.
• C. Reduce the feeding rate and monitor for improvement.
• D. Add fiber to the client's diet to resolve diarrhea.

Correct answer: B

Rationale: When a client develops diarrhea from continuous enteral tube feeding, diluting the feeding to half strength and continuing at the same rate is the appropriate intervention. This helps reduce the strength of the feeding, minimizing gastrointestinal upset while still providing necessary nutrition. Stopping the feeding abruptly (Choice A) may lead to nutritional deficits. Simply reducing the feeding rate (Choice C) may not effectively address the issue of diarrhea. Adding fiber (Choice D) could potentially worsen the diarrhea in this scenario instead of resolving it.

3. A client with Cushing's syndrome presents with excessive bruising and elevated blood glucose. What action should the nurse take first?

• A. Check the client's blood glucose level.
• B. Administer insulin per sliding scale protocol.
• C. Administer intravenous fluids.
• D. Check the client's skin for signs of bruising.

Correct answer: A

Rationale: Excessive bruising and elevated blood glucose are common symptoms of Cushing's syndrome. The nurse should first check the client's blood glucose level to assess and address the hyperglycemia promptly. Administering insulin or IV fluids would be premature without knowing the current blood glucose level. Checking the skin for bruising, although important for overall assessment, does not address the immediate concern of elevated blood glucose.

4. When teaching a group of mothers of young children about emergency care for poisoning, which of the following statements should be included?

• A. Induce vomiting immediately after the poison ingestion
• B. Call the local Poison Control Center after inducing vomiting
• C. Call the Poison Control Center prior to any interventions
• D. Take the child to the emergency department before calling the Poison Control Center

Correct answer: C

Rationale: The correct statement to include when teaching about emergency care for poisoning is to call the Poison Control Center prior to any interventions. This is important because the Poison Control Center can provide guidance on the appropriate steps to take based on the type of poisoning, the amount ingested, and the age of the child. Inducing vomiting without professional advice can sometimes do more harm than good. Choice A is incorrect because inducing vomiting immediately is not recommended without consulting with professionals. Choice B is incorrect as it suggests calling the Poison Control Center after inducing vomiting, which is not the recommended sequence. Choice D is incorrect because it is advisable to contact the Poison Control Center first before taking the child to the emergency department.

5. A client with Addison's disease becomes confused and weak. What is the nurse's first action?

• A. Administer a dose of hydrocortisone immediately.
• B. Check the client’s electrolyte levels.
• C. Administer a dose of normal saline.
• D. Measure the client’s blood pressure in both arms.

Correct answer: A

Rationale: The correct answer is to administer a dose of hydrocortisone immediately. In Addison's disease, confusion and weakness can be signs of an adrenal crisis. Administering hydrocortisone promptly is crucial to prevent further deterioration. Checking electrolyte levels (Choice B) is important but not the first action in managing an acute adrenal crisis. Administering normal saline (Choice C) is not the priority in this situation. Measuring blood pressure in both arms (Choice D) is not the initial action needed to address the client's confusion and weakness in Addison's disease.

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