Nursing Elites

1. A middle-aged male client with diabetes continues to eat an abundance of foods that are high in sugar and fat. According to the Health Belief Model, which event is most likely to increase the client's willingness to become compliant with the prescribed diet?

• A. He visits his diabetic brother who just had surgery to amputate an infected foot.
• B. He is provided with the most current information about the dangers of untreated diabetes.
• C. He comments on the community service announcements about preventing complications associated with diabetes.
• D. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet.

Correct answer: A

Rationale: According to the Health Belief Model, the most effective event to increase compliance with the prescribed diet for a middle-aged male client with diabetes is experiencing a significant consequence related to the disease. In this case, visiting his diabetic brother who just had surgery to amputate an infected foot would serve as a strong 'cue to action,' increasing the client's perceived seriousness of the disease. This event is likely to have a more immediate and impactful effect on the client than other options. Option B provides valuable information but may not have the same personal and emotional impact as witnessing a severe consequence firsthand. Option C involves indirect exposure to prevention messages, which might not be as compelling as a direct experience. Option D, while supportive, does not present a direct consequence of non-compliance like option A does.

2. A client is recovering from a closed percutaneous kidney biopsy and reports increased pain from 3 to 10 on a scale of 0 to 10. Which action should the nurse take first?

• A. Reposition the client on the operative side.
• B. Administer the prescribed opioid analgesic.
• C. Assess the pulse rate and blood pressure.
• D. Examine the color of the client’s urine.

Correct answer: C

Rationale: An abrupt increase in pain following a percutaneous kidney biopsy may indicate internal hemorrhage. Assessing the client's pulse rate and blood pressure is crucial as changes in vital signs can be indicative of hemorrhage. This assessment is essential in determining the client's hemodynamic status and the need for immediate intervention. Repositioning the client, administering pain medication, or checking urine color are not the priority actions in this situation and may delay necessary interventions for potential hemorrhage.

3. To assess the quality of an adult client's pain, what approach should the nurse use?

• A. Observe body language and movement.
• B. Ask the client to describe the pain.
• C. Identify effective pain relief measures.
• D. Provide a numeric pain scale.

Correct answer: B

Rationale: The correct answer is to ask the client to describe the pain. This approach allows the nurse to gather subjective information directly from the client, such as the quality, intensity, location, and factors that aggravate or alleviate the pain. Observing body language and movement (Choice A) can provide additional cues but may not fully capture the client's pain experience. Identifying effective pain relief measures (Choice C) and providing a numeric pain scale (Choice D) are important aspects of pain management but do not directly assess the quality of the client's pain.

4. In a client with congestive heart failure, the nurse would be correct in withholding a dose of digoxin without specific instruction from the healthcare provider if the client's

• A. serum digoxin level is 1.5 ng/mL.
• B. blood pressure is 104/68 mmHg.
• C. serum potassium level is 3 mEq/L.
• D. apical pulse is 68/min.

Correct answer: C

Rationale: The correct answer is C. Hypokalemia can precipitate digitalis toxicity in individuals on digoxin, increasing the risk of dangerous dysrhythmias. A serum potassium level of 3 mEq/L is below the normal range (3.5 to 5.5 mEq/L) and indicates hypokalemia, which can potentiate the effects of digoxin. Choices A, B, and D are not directly related to the potential for digitalis toxicity. Serum digoxin level of 1.5 ng/mL is within the therapeutic range, blood pressure of 104/68 mmHg is not a contraindication for administering digoxin, and an apical pulse of 68/min is within the normal range and not a reason to withhold digoxin.

5. The client is planning care for a client who is receiving hemodialysis. Which of the following interventions should be included in the plan of care?

• A. Administer anticoagulants to prevent clot formation.
• B. Monitor the client for signs of infection.
• C. Provide the client with a high-protein diet.
• D. Encourage the client to drink at least 2 liters of fluid daily.

Correct answer: B

Rationale: Monitoring for signs of infection is crucial in clients receiving hemodialysis because they are at an increased risk of infection due to the invasive nature of the procedure. Administering anticoagulants is not typically a part of the routine care for clients undergoing hemodialysis unless specifically prescribed. While a high-protein diet may be beneficial for some clients, it is not a specific intervention related to hemodialysis. Encouraging fluid intake must be individualized based on the client's fluid status and should not be a generalized recommendation for all clients receiving hemodialysis.

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