Nursing Elites

1. A client with viral hepatitis has no appetite, and food makes the client nauseated. Which of the following interventions would be most appropriate?

• A. Explain that high-fat diets usually are tolerated better.
• B. Encourage intake of foods high in protein.
• C. Explain that the majority of calories need to be consumed in the evening hours.
• D. Monitor for fluid and electrolyte imbalance.

Correct answer: D

Rationale: If nausea occurs and persists, the client will need to be assessed for fluid and electrolyte imbalance. Explaining to the client that the majority of calories should be eaten in the morning hours is important because nausea occurs most often in the afternoon and evening. Clients should select a diet high in calories because energy is required for healing. Protein increases the workload on the liver. Changes in bilirubin interfere with fat absorption, so low-fat diets are tolerated better.

2. A client with viral hepatitis states, 'I am so yellow.' The nurse most appropriately would

• A. Assist the client in expressing feelings.
• B. Do most of the activities of daily living for the client.
• C. Provide information to the client only when the client requests it.
• D. Restrict visitors until the jaundice subsides.

Correct answer: A

Rationale: To assist the client in adapting to changes in appearance, the nurse must encourage participation in self-care to foster independence and self-esteem. The nurse should encourage the client to ask questions to clarify misconceptions, learn ways to prevent the spread of hepatitis to reduce fear, and make appropriate decisions. Restricting visitors will reinforce the client’s negative self-esteem.

3. A client had an abdominal perineal resection with a colostomy 4 days ago and is ready for discharge. Which of the following would be an appropriate expected outcome at this point?

• A. The client maintains a high-fiber diet.
• B. The client discusses concerns about his sexual functioning.
• C. The client maintains bedrest.
• D. The client limits fluid intake to 1000 ml/day.

Correct answer: B

Rationale: Clients often have concerns about their sexuality after a fecal diversion. The nurse should encourage the client to discuss any questions about sexual functioning. The client will not need to maintain a high-fiber diet but will be encouraged to avoid any foods that cause odor and flatulence. The client should be able to ambulate and sit out of bed for several hours at a time at this point. Fluid intake will be encouraged, not restricted.

4. Surgical management of ulcerative colitis may be performed to treat which of the following complications?

• A. Gastritis
• B. Bowel herniation
• C. Bowel outpouching
• D. Bowel perforation

Correct answer: D

Rationale: Surgical management of ulcerative colitis may be necessary to treat complications such as bowel perforation.

5. If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?

• A. Blood replacement
• B. Antacid administration
• C. Nasogastric tube suction
• D. Fluid and electrolyte replacement

Correct answer: B

Rationale: Antacid administration should not be included in the immediate management of a gastric perforation.

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