Nursing Elites

1. A client is experiencing an acute exacerbation of Crohn's disease. Which of the following actions should the nurse take?

• A. Encourage the client to increase dietary fiber.
• B. Maintain the client on a low-residue diet.
• C. Provide the client with frequent high-calorie snacks.
• D. Encourage the client to eat a high-fiber diet.

Correct answer: B

Rationale: During an acute exacerbation of Crohn's disease, the nurse should maintain the client on a low-residue diet. This diet helps to minimize bowel irritation by reducing the volume and frequency of stools. Choices A, C, and D are incorrect. Encouraging the client to increase dietary fiber (Choice A) and eat a high-fiber diet (Choice D) can worsen symptoms and aggravate bowel inflammation in Crohn's disease. Providing the client with frequent high-calorie snacks (Choice C) may not be appropriate during an exacerbation since high-fat foods can be harder to digest and may exacerbate symptoms.

2. A nurse is reviewing the laboratory report of a client who has been receiving lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8 mEq/L. Which of the following orders from the provider should the nurse expect?

• A. Withhold the next dose.
• B. Increase the dosage.
• C. Discontinue the medication.
• D. Administer the medication.

Correct answer: D

Rationale: Administering the medication is appropriate for a stable lithium level of 0.8 mEq/L. A level of 0.8 mEq/L falls within the therapeutic range for lithium, indicating that the client is receiving an adequate dose to maintain therapeutic effects. Withholding the next dose, increasing the dosage, or discontinuing the medication would not be indicated at this lithium level as it is within the desired range for therapeutic benefit. Therefore, the correct action would be to continue administering the medication to ensure the client maintains the therapeutic level of lithium.

3. A nurse is reviewing the plan of care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse expect to include?

• A. Encourage group activities to promote socialization.
• B. Encourage the client to take frequent naps throughout the day.
• C. Provide the client with frequent high-calorie snacks.
• D. Promote physical activity during mealtimes to stimulate appetite.

Correct answer: C

Rationale: Providing high-calorie snacks is essential when caring for a client in the manic phase of bipolar disorder because they often have increased energy expenditure and may not eat adequately due to their heightened activity levels. Encouraging group activities (Choice A) may overwhelm the client further during this phase. Encouraging frequent naps (Choice B) contradicts the need to manage increased energy levels. Promoting physical activity during mealtimes (Choice D) may not be appropriate as it can distract the client from eating, which is crucial in meeting their nutritional needs.

4. A nurse is preparing to administer a rectal suppository to a client. What action should the nurse take?

• A. Encourage the client to hold their breath as long as possible.
• B. Insert the suppository just past the anal sphincter.
• C. Lubricate the suppository and insert it 1.5 cm (0.6 in) into the rectum.
• D. Place the client in a Sims' position before inserting the suppository.

Correct answer: D

Rationale: The correct action the nurse should take when administering a rectal suppository is to place the client in a Sims' position. This position helps facilitate the proper administration of the suppository by allowing better access to the rectum. Encouraging the client to hold their breath as long as possible (Choice A) is unnecessary and not related to the administration of a rectal suppository. Inserting the suppository just past the anal sphincter (Choice B) is incorrect as it may not reach the rectum where it needs to be placed. Lubricating the suppository and inserting it 1.5 cm into the rectum (Choice C) is incorrect as the suppository needs to be inserted deeper into the rectum for proper absorption.

5. A client is postoperative following a total knee arthroplasty. Which of the following instructions should the nurse include in the discharge teaching?

• A. Cross your legs when sitting to prevent discomfort.
• B. Perform range-of-motion exercises every 4 hours.
• C. Wear compression stockings daily.
• D. Apply heat to the incision site daily.

Correct answer: C

Rationale: The correct answer is C: 'Wear compression stockings daily.' Wearing compression stockings is essential after knee surgery to prevent venous stasis and reduce the risk of blood clots. Choice A is incorrect as crossing legs when sitting can increase the risk of blood clots. Choice B is incorrect because performing range-of-motion exercises every 4 hours may not be suitable for all clients post total knee arthroplasty. Choice D is incorrect as applying heat to the incision site can increase the risk of infection.

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