Nursing Elites

1. A nurse is caring for a client who is receiving continuous enteral feeding through a nasogastric tube. Which of the following actions should the nurse take to prevent aspiration?

• A. Flush the tube with 30 mL of water every 4 hours.
• B. Position the client on the left side during feedings.
• C. Elevate the head of the bed to 45 degrees during feedings.
• D. Check gastric residual every 2 hours.

Correct answer: C

Rationale: To prevent aspiration in clients receiving continuous enteral feedings, the nurse should elevate the head of the bed to 45 degrees. This position helps reduce the risk of regurgitation and aspiration. Flushing the tube with water every 4 hours (Choice A) is important for maintaining tube patency but does not directly prevent aspiration. Positioning the client on the left side during feedings (Choice B) is not specifically related to preventing aspiration in this context. Checking gastric residual every 2 hours (Choice D) is important to assess feeding tolerance but does not directly prevent aspiration.

2. A nurse is caring for a client who has a prescription for a low-sodium diet. Which of the following foods should the nurse recommend?

• A. Pickles
• B. Fresh vegetables
• C. Canned soup
• D. Smoked salmon

Correct answer: B

Rationale: Fresh vegetables are an excellent choice for clients on a low-sodium diet as they are naturally low in sodium. Pickles, canned soup, and smoked salmon are high in sodium and should be avoided by clients following a low-sodium diet. Pickles are pickled in a brine solution high in sodium, canned soup usually contains added salt for preservation, and smoked salmon is a processed food that typically has a high sodium content.

3. A nurse is caring for a client who has a history of alcohol use disorder and is experiencing withdrawal. Which of the following actions should the nurse take?

• A. Administer naloxone
• B. Administer diazepam
• C. Encourage oral fluid intake
• D. Administer magnesium sulfate

Correct answer: B

Rationale: The correct action for the nurse to take when caring for a client with alcohol use disorder experiencing withdrawal is to administer diazepam. Diazepam is a benzodiazepine commonly used to manage withdrawal symptoms in these clients by reducing anxiety, tremors, and the risk of seizures. Administering naloxone (Choice A) is used for opioid overdose, not alcohol withdrawal. Encouraging oral fluid intake (Choice C) is generally beneficial but not a specific intervention for alcohol withdrawal. Administering magnesium sulfate (Choice D) is not indicated for alcohol withdrawal but may be used for other conditions like preeclampsia or eclampsia.

4. A nurse is teaching a newly licensed nurse about ergonomic principles. Which action by the newly licensed nurse indicates an understanding of the teaching?

• A. Stand with feet together when lifting a client.
• B. Raise the client's head of bed before pulling the client up.
• C. Use a mechanical lift to move a client.
• D. Place a gait belt around the client's chest before assisting the client.

Correct answer: C

Rationale: The correct answer is C: 'Use a mechanical lift to move a client.' Using a mechanical lift is an essential ergonomic principle to prevent injury and ensure safe client handling. Choice A is incorrect because standing with feet together when lifting a client can lead to instability and improper weight distribution. Choice B is incorrect as raising the client's head of bed before pulling the client up does not primarily relate to ergonomic principles. Choice D is incorrect because while using a gait belt is important for assisting clients with mobility, it is not specifically related to ergonomic principles for safe handling.

5. A client has a prescription for digoxin. Which of the following instructions should the nurse include?

• A. Take this medication with food.
• B. Avoid taking antacids at the same time as this medication.
• C. Take this medication if your heart rate is above 100/min.
• D. Notify your provider if you experience nausea or visual changes.

Correct answer: D

Rationale: The correct instruction the nurse should include for a client prescribed digoxin is to notify the provider if they experience nausea or visual changes, as these symptoms can indicate digoxin toxicity. Option A is incorrect because digoxin should be taken on an empty stomach for better absorption. Option B is incorrect as antacids can interfere with the absorption of digoxin. Option C is incorrect as taking digoxin based on heart rate alone is not appropriate.

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