Nursing Elites

1. A client with hepatic encephalopathy is being cared for by a nurse. Which food selection indicates the client understands dietary teaching?

• A. A sandwich and milkshake
• B. Rice with black beans
• C. Cottage cheese and tuna lettuce
• D. Three-egg omelet with low-sodium ham

Correct answer: B

Rationale: For clients with hepatic encephalopathy, foods high in protein like cottage cheese and tuna should be avoided. Plant-based protein sources like beans are recommended due to their lower ammonia production during digestion. Therefore, the correct choice is B. Choices A, C, and D are incorrect as they include high-protein or high-sodium foods that can worsen the condition of hepatic encephalopathy.

2. A nurse in a provider's office is assessing the motor skill development of a 15-month-old toddler during a well-child visit. What gross motor skills should the nurse expect to observe?

• A. Walks without assistance using a wide stance
• B. Climbs stairs with assistance
• C. Runs smoothly
• D. Kicks a ball forward

Correct answer: A

Rationale: The correct answer is A. At 15 months, toddlers typically walk independently but may do so with a wide stance for balance. Choice B, climbing stairs with assistance, is more common around 18 months. Choice C, running smoothly, is usually achieved around 2 years of age. Choice D, kicking a ball forward, generally develops around 2 to 3 years of age. Therefore, for a 15-month-old toddler, the nurse should expect the child to walk without assistance using a wide stance for balance.

3. A nurse is caring for a client who has been taking haloperidol for several years. Which of the following assessment findings should the nurse recognize as a long-term side effect of this medication?

• A. Lip-smacking
• B. Agranulocytosis
• C. Clang association
• D. Alopecia

Correct answer: A

Rationale: Lip-smacking is a symptom of tardive dyskinesia, a long-term side effect of antipsychotic medications like haloperidol, characterized by involuntary movements of the face and jaw. Agranulocytosis (Choice B) is a rare but serious side effect of some medications, characterized by a dangerously low white blood cell count. Clang association (Choice C) is a thought disorder characterized by the association of words based on sound rather than meaning. Alopecia (Choice D) refers to hair loss, which is not a known long-term side effect of haloperidol.

4. During a change-of-shift assessment, a nurse is evaluating four clients. Which finding should the nurse report to the provider first?

• A. Client with cystic fibrosis who has a thick productive cough and reports thirst
• B. Client with gastroenteritis who is lethargic and confused
• C. Client with diabetes mellitus who has a morning fasting glucose of 185 mg/dL
• D. Client with sickle cell anemia who reports pain 15 minutes after receiving analgesic

Correct answer: B

Rationale: The nurse should report the client with gastroenteritis who is lethargic and confused to the provider first. Lethargy and confusion in a client with gastroenteritis may indicate dehydration or electrolyte imbalance, both of which can be life-threatening if not addressed promptly. The other options indicate important assessments that require intervention but do not pose an immediate life-threatening risk compared to the client with signs of dehydration and electrolyte imbalance.

5. A healthcare provider is reviewing a prescription for doxazosin with a client. Which instruction should the healthcare provider provide?

• A. Decrease caloric intake to reduce weight gain
• B. Increase dietary fiber to prevent constipation
• C. Rise slowly when sitting up
• D. Take this medication each morning

Correct answer: C

Rationale: The correct instruction for a client prescribed with doxazosin is to rise slowly when sitting up. Doxazosin can cause orthostatic hypotension, leading to dizziness upon sudden position changes. Instructing the client to rise slowly helps prevent this side effect. Choices A, B, and D are incorrect because they are not directly related to the potential side effects or administration of doxazosin.

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