Nursing Elites

1. A nurse is caring for a client who has anemia and a hemoglobin level of 8 g/dL. Which of the following findings should the nurse expect?

• A. Jaundice.
• B. Bradycardia.
• C. Tachypnea.
• D. Hypertension.

Correct answer: C

Rationale: The correct answer is C: Tachypnea. Anemia leads to decreased oxygen-carrying capacity due to low hemoglobin levels, prompting the body to increase respiratory rate to enhance oxygen uptake. Jaundice (choice A) is associated with liver issues, not anemia. Bradycardia (choice B) and Hypertension (choice D) are not typically expected findings in clients with anemia; instead, tachycardia may occur as the body compensates for the decreased oxygen delivery.

2. A nurse is performing a dressing change for a client who has a sacral wound using negative pressure wound therapy. Which of the following actions should the nurse take first?

• A. Apply skin preparation to wound edges.
• B. Don sterile gloves.
• C. Normal saline
• D. Determine pain level.

Correct answer: D

Rationale: The correct answer is to determine the pain level first. Assessing the client's pain is crucial before any procedure to ensure their comfort and safety. Applying skin preparation to wound edges (Choice A) may come later in the process after ensuring the client's comfort. Donning sterile gloves (Choice B) is important before directly handling the wound but can follow pain assessment. Normal saline (Choice C) might be used during wound cleansing but is not the initial step in this situation.

3. A client has a new prescription for furosemide. Which of the following instructions should the nurse include?

• A. Take this medication with a meal.
• B. Increase your intake of potassium-rich foods.
• C. Avoid prolonged exposure to sunlight.
• D. Limit your intake of calcium-rich foods.

Correct answer: B

Rationale: The correct instruction for a client taking furosemide is to increase their intake of potassium-rich foods. Furosemide is a loop diuretic that can lead to potassium loss, so increasing potassium-rich foods helps prevent hypokalemia. Choice A is incorrect because furosemide is usually taken on an empty stomach. Choice C is unrelated to furosemide therapy. Choice D is incorrect as there is no need to limit calcium-rich foods while taking furosemide.

4. A client who is 48 hours postoperative following abdominal surgery is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

• A. Heart rate of 80/min
• B. Sanguineous drainage on the surgical dressing
• C. Temperature of 37.5°C (99.5°F)
• D. Serous drainage on the surgical dressing

Correct answer: B

Rationale: Sanguineous drainage from the surgical site 48 hours after surgery could indicate a complication such as hemorrhage or infection and should be reported. Sanguineous drainage is typically seen in the early postoperative period due to the presence of blood. Serous drainage, on the other hand, is normal in the later stages of wound healing. A heart rate of 80/min is within the normal range for an adult. A temperature of 37.5°C (99.5°F) is slightly elevated but not a concerning finding in the absence of other symptoms.

5. A client with gastroesophageal reflux disease (GERD) is receiving teaching from a nurse. Which of the following instructions should the nurse include?

• A. Lie down after meals to reduce discomfort.
• B. Limit fluid intake to 1 liter per day.
• C. Avoid eating spicy foods.
• D. Eat three large meals each day.

Correct answer: C

Rationale: The correct answer is C: 'Avoid eating spicy foods.' Spicy foods can exacerbate symptoms of GERD by irritating the esophagus and causing discomfort. It is important for clients with GERD to avoid spicy foods to help manage their condition. Choices A, B, and D are incorrect. A client with GERD should not lie down after meals as this can worsen symptoms, limiting fluid intake to only 1 liter per day may not be appropriate for everyone, and eating three large meals each day can put pressure on the stomach and worsen GERD symptoms.

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