Nursing Elites

1. While caring for a client who begins to experience a generalized seizure while standing in her room, which of the following actions should the nurse take?

• A. Place a pad under the client’s head
• B. Hold the client’s limbs tightly to prevent injury
• C. Lift the client into bed with the help of other staff members
• D. Insert a bite block into the client’s mouth

Correct answer: A

Rationale: During a seizure, the priority is to protect the client's head and ensure their safety. The nurse should guide the client to the ground if possible and place a soft pad or a folded cloth under the head to prevent injury. Restraining the client's limbs can result in injury and should be avoided. Lifting the client can also lead to injuries during a seizure. Inserting a bite block is contraindicated as it can cause damage to the teeth, oral tissues, and obstruct the airway. Therefore, the correct action is to place a pad under the client's head to protect them during the seizure.

2. When applying an ice bag to a client's ankle following a sports injury, which of the following actions should the nurse take?

• A. Fill the bag two-thirds full with ice.
• B. Apply the ice bag directly to the skin with a barrier.
• C. Keep the ice bag on for more than 30 minutes at a time.
• D. Use a frozen gel pack instead of ice.

Correct answer: A

Rationale: Filling the ice bag two-thirds full is the correct action as it ensures the effectiveness of the ice application while allowing some space for the ice to move and conform to the injury. Choice B is incorrect because the ice bag should be applied with a barrier like a cloth to prevent direct contact with the skin, which can lead to ice burns. Choice C is wrong as ice should typically be applied for 20 minutes at a time to avoid tissue damage. Choice D is also incorrect as ice is preferred over frozen gel packs for immediate sports injury management.

3. A middle adult client tells the nurse, 'I feel so useless now that my children do not need me anymore.' Which of the following responses should the nurse make?

• A. People in middle adulthood often find satisfaction in nurturing and guiding young people.
• B. It's normal to feel this way; it will pass.
• C. You should focus on finding new activities to fill your time.
• D. Your children will always need you in some way.

Correct answer: A

Rationale: The correct response is A. Middle adulthood is a stage where individuals often experience generativity, finding fulfillment in guiding and nurturing others. By acknowledging this aspect, the nurse can help the client explore opportunities to engage in activities that provide a sense of purpose and satisfaction. Choice A validates the client's feelings and offers a constructive way to address them. Choices B, C, and D do not address the client's emotional need for purpose and may not encourage the client to seek meaningful ways to address their feelings of uselessness.

4. A client is being taught about dietary management of hypercholesterolemia. Which of the following foods should be suggested to add to the diet?

• A. Avocados
• B. Fried chicken
• C. Whole milk
• D. Bacon

Correct answer: A

Rationale: Avocados are a good choice to suggest adding to the diet of a client with hypercholesterolemia because they are high in healthy fats, particularly monounsaturated fats, which can help manage cholesterol levels. On the other hand, fried chicken, whole milk, and bacon are high in saturated fats and cholesterol, which should be limited in a diet aimed at managing hypercholesterolemia. Therefore, choices B, C, and D are incorrect.

5. A nurse is planning care for a client who has hypernatremia. Which of the following actions should the nurse include in the plan of care?

• A. Infuse hypotonic IV fluids.
• B. Implement a fluid restriction.
• C. Increase sodium intake.
• D. Administer sodium polystyrene sulfonate.

Correct answer: A

Rationale: The correct answer is to infuse hypotonic IV fluids. In hypernatremia, there is an elevated sodium concentration in the blood, and diluting it with hypotonic fluids helps to lower the sodium levels. Implementing a fluid restriction or increasing sodium intake would worsen hypernatremia by further concentrating sodium in the body. Administering sodium polystyrene sulfonate is used for treating hyperkalemia, not hypernatremia.

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