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. When preparing the client with hepatitis A for extended convalescence, the nurse teaches the client about problems that may occur. The nurse knows that the client has understood the teaching when he says that he is most likely to have difficulty:

• A. Controlling abdominal pain.
• B. Maintaining a regular bowel elimination pattern.
• C. Preventing respiratory complications.
• D. Maintaining a positive, optimistic outlook.

Correct answer: D

Rationale: Convalescence after hepatitis A may take weeks or even months. Boredom and depression are common problems that the client should anticipate. Abdominal pain is not usually a symptom of hepatitis A. Maintaining a regular bowel elimination pattern is not usually a problem with hepatitis. Problems preventing respiratory complications are unlikely. To support healing, activity is strictly limited but bed rest is not prescribed.

3. A client is providing instructions to a client who is scheduled for an oral cholecystogram. The nurse tells the client to

• A. Eat a fat-free meal on the evening before the procedure.
• B. Maintain strict NPO status on the day of the procedure.
• C. Avoid oral intake except for water on the day of the procedure.
• D. Eat a high-fat meal for breakfast on the day of the procedure.

Correct answer: C

Rationale: For an oral cholecystogram, the client should eat a fat-free meal the evening before the procedure and avoid oral intake except for water on the day of the procedure. During the test, the client may be given a high-fat meal or drink to stimulate gallbladder emptying. Choice A is incorrect because the client should have a fat-free meal, not a high-fat meal. Choice B is incorrect as strict NPO status is not required. Choice D is incorrect as a high-fat meal is not recommended for breakfast on the day of the procedure.

4. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care?

• A. Low-fiber diet and fluid restrictions.
• B. Total parenteral nutrition and bed rest.
• C. High-fiber diet and administration of psyllium.
• D. Administration of analgesics and antacids.

Correct answer: C

Rationale: Care for a patient with diverticulosis includes a high-fiber diet and administration of psyllium.

5. A 30-year-old woman is admitted to the hospital with complaints of severe abdominal cramping and diarrhea. The nurse evaluates the effectiveness of the patient's intravenous therapy. Which of the following laboratory tests BEST reflects hydration status?

• A. Erythrocyte sedimentation rate.
• B. White blood cell count.
• C. Hematocrit.
• D. Serum glucose.

Correct answer: C

Rationale: Hematocrit is the best indicator of hydration status because it reflects the proportion of red blood cells in the blood. An increased hematocrit indicates dehydration, as the blood becomes more concentrated due to fluid loss. Erythrocyte sedimentation rate (Choice A) is a nonspecific marker of inflammation, not hydration status. White blood cell count (Choice B) is an indicator of infection or inflammation. Serum glucose (Choice D) is used to monitor blood sugar levels, not hydration status.

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