Nursing Elites

1. A nurse is giving dietary instructions to a client who has a new colostomy. The nurse encourages the client to eat foods representing which of the following diets for the first 4 to 6 weeks postoperatively?

• A. High-protein
• B. High-carbohydrate
• C. Low-calorie
• D. Low-residue

Correct answer: D

Rationale: For the first 4 to 6 weeks following colostomy formation, the client should take in a low-residue diet. Following this period, the client should eat a high-carbohydrate, high-protein diet. The nurse also instructs the client to add new foods, one at a time, to determine tolerance to that food.

2. The nurse provides discharge instructions to a patient with hepatitis B. Which of the following statements, if made by the patient, would indicate the need for further instruction?

• A. I can never donate blood.
• B. I can never have unprotected sex.
• C. I cannot share needles.
• D. I should avoid drugs and alcohol.

Correct answer: D

Rationale: The correct answer is D. This patient statement indicates a need for further teaching. The patient should be instructed that, in order to avoid complications, alcohol should be avoided for six months to one year. Illicit drugs and toxic chemicals should also be avoided. Acetaminophen may be taken only when necessary and not beyond the recommended dosage. Choices A, B, and C are correct statements regarding precautions to prevent the spread of hepatitis B and do not indicate a need for further instruction.

3. A client with which of the following conditions may be likely to develop rectal cancer?

• A. Adenomatous polyps
• B. Diverticulitis
• C. Hemorrhoids
• D. Peptic ulcer disease

Correct answer: A

Rationale: Adenomatous polyps are a known risk factor for the development of rectal cancer.

4. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

• A. He has fresh, active upper GI bleeding.
• B. He needs immediate saline gastric lavage.
• C. His gastric bleeding occurred 2 hours earlier.
• D. He needs a transfusion of packed RBCs.

Correct answer: C

Rationale: Coffee-ground emesis is a sign of upper gastrointestinal bleeding that occurred approximately 2 hours earlier. It results from the breakdown of blood in the stomach due to digestive enzymes, giving it a coffee-ground appearance. Choice A is incorrect because coffee-ground emesis indicates older, partially digested blood, not fresh active bleeding. Choice B is incorrect as gastric lavage is not indicated for coffee-ground emesis. Choice D is incorrect because a transfusion of packed RBCs is not the immediate management for this presentation.

5. The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which of the following assessment questions most specifically would elicit information regarding the pain that is associated with acute pancreatitis?

• A. Does the pain in your abdomen radiate to your groin.
• B. Does the pain in your stomach radiate to the back?
• C. Does the pain in your stomach radiate to your lower middle abdomen?
• D. Does the pain in your lower abdomen radiate to the hip?

Correct answer: B

Rationale: The pain that is associated with acute pancreatitis is often severe and is located in the epigastric region and radiates to the back. Options 1, 3, and 4 are incorrect because they are not specific for the pain experienced by the client with pancreatitis.

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