Nursing Elites

1. A nurse is planning care for a client who has ascites secondary to liver disease. Which of the following interventions should the nurse include in the plan of care?

• A. Reduce complex carbohydrates to 30% of total calories.
• B. Restrict protein intake to less than 0.8 g/kg/day.
• C. Decrease daily caloric intake by 20%.
• D. Limit sodium to 2000 mg or less per day.

Correct answer: D

Rationale: Limiting sodium to 2000 mg or less per day helps manage fluid retention associated with ascites in liver disease.

2. A nurse is evaluating the meal choices of a client who has major depressive disorder and a prescription of Phenelzine. Which of the following selections should the nurse identify as appropriate?

• A. Cheddar cheese
• B. Smoked salmon
• C. Strawberry yogurt
• D. Pepperoni pizza

Correct answer: C

Rationale: Strawberry yogurt is appropriate as it does not contain high levels of tyramine, which can interact negatively with Phenelzine.

3. A nurse is caring for a client who is lactose intolerant. Which of the following clinical manifestations should the nurse assess be?

• A. Fever
• B. Blood stools
• C. Cramping
• D. Steatorrhea

Correct answer: C

Rationale: Cramping is a common clinical manifestation of lactose intolerance due to the inability to digest lactose properly.

4. A nurse is caring for a client who is receiving a continuous enteral tube feeding and reports cramping and abdominal distention. Which of the following actions should the nurse take?

• A. Check for gastric residual.
• B. Apply low intermittent suction.
• C. Increase the rate of the feeding.
• D. Request a higher-fat formula.

Correct answer: A

Rationale: Checking for gastric residual can help identify the cause of cramping and abdominal distention during enteral feedings.

5. A nurse is reviewing the lab findings of a client who has Clostridium Difficile. Which of the following findings should indicate to the nurse that the client is experiencing Fluid Volume Deficit?

• A. Hct 53%
• B. Potassium 3.5
• C. Sodium 145
• D. HbA1c 5

Correct answer: A

Rationale: An elevated hematocrit level (Hct 53%) indicates hemoconcentration, a sign of fluid volume deficit.

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