Nursing Elites

1. A client has a prescription for a clear liquid diet. Which of the following foods should the nurse offer?

• A. Milk
• B. Vegetable juice
• C. Chicken broth
• D. Orange juice with pulp

Correct answer: C

Rationale: A clear liquid diet consists of easily digestible transparent liquids. Chicken broth is an appropriate choice as it meets the criteria of being clear and liquid, making it suitable for a clear liquid diet. Milk, vegetable juice, and orange juice with pulp are not considered clear liquids. Milk is not transparent, vegetable juice is not clear, and orange juice with pulp contains solid particles, all of which do not align with the requirements of a clear liquid diet.

2. A client has a new prescription for a potassium-sparing diuretic. Which of the following foods should the nurse recommend?

• A. Bananas
• B. Oranges
• C. Spinach
• D. Apples

Correct answer: D

Rationale: Clients on potassium-sparing diuretics need to avoid high-potassium foods to prevent hyperkalemia. Apples are a low-potassium fruit, making them a suitable recommendation for clients on this type of diuretic. Bananas, oranges, and spinach are high-potassium foods that should be avoided by clients taking potassium-sparing diuretics to prevent complications such as hyperkalemia.

3. A healthcare professional is preparing to insert an IV catheter for an older adult client. Which of the following actions should the professional take?

• A. Shave the hair at the insertion site.
• B. Insert the catheter at a 45-degree angle.
• C. Place the client’s arm in a dependent position.
• D. Use a tourniquet to dilate the veins.

Correct answer: C

Rationale: Placing the client’s arm in a dependent position is the correct action when preparing to insert an IV catheter in an older adult client. This position helps dilate the veins naturally by using gravity, making it easier to locate and access suitable veins for the IV catheter insertion. By positioning the arm in a dependent position, the healthcare professional can take advantage of gravity to increase venous distention, aiding in successful IV catheter insertion.

4. When planning care for a client with a pressure ulcer, which intervention should the nurse include in the plan?

• A. Massage the reddened area.
• B. Apply a donut-shaped cushion.
• C. Reposition the client every 3 hours.
• D. Use a transparent film dressing.

Correct answer: D

Rationale: The correct intervention for a client with a pressure ulcer is to use a transparent film dressing. This dressing provides a protective barrier against external contaminants while allowing for wound inspection, promoting healing. Massaging the reddened area can cause further damage to the skin and should be avoided. Donut-shaped cushions can increase pressure on the ulcer site rather than alleviate it. Repositioning the client every 2 hours is a preventive measure for pressure ulcers, but once an ulcer has developed, using a transparent film dressing is a more appropriate intervention to facilitate healing and protect the wound site.

5. Which of the following techniques should be used to insert an indwelling urinary catheter for a female client?

• A. Use sterile technique.
• B. Insert the catheter 2-3 inches into the urethra.
• C. Inflate the balloon after insertion.
• D. Lubricate the catheter tip before insertion.

Correct answer: D

Rationale: Lubricating the catheter tip before insertion is crucial for female urinary catheterization. This step helps reduce discomfort for the patient and facilitates smooth catheter insertion into the urethra. Using sterile technique maintains asepsis during the procedure, inserting the catheter 2-3 inches ensures proper placement, and inflating the balloon after insertion secures the catheter in place without causing trauma. Proper technique is fundamental for patient comfort, preventing infection, and ensuring the success of the catheterization procedure.

Similar Questions