Nursing Elites

1. A client with a new diagnosis of Crohn's disease is receiving teaching from a nurse. Which statement by the client demonstrates an understanding of the teaching?

• A. I should eat more fiber to help with my bowel movements.
• B. I will need to have routine colonoscopies to monitor my condition.
• C. I will limit my intake of whole grains.
• D. I should consume a low-fat diet.

Correct answer: B

Rationale: The correct answer is B. Clients with Crohn's disease require routine colonoscopies to monitor disease progression and complications. This helps healthcare providers assess the status of the disease and make informed treatment decisions. Choice A is incorrect because while fiber may be beneficial for some digestive conditions, it can exacerbate symptoms in Crohn's disease. Choice C is incorrect as whole grains can be a good source of nutrients unless they individually trigger symptoms in the client. Choice D is also incorrect since a low-fat diet is not a specific requirement for managing Crohn's disease.

2. A client who is postpartum requests information about contraception. Which of the following instructions should the nurse include?

• A. The lactation amenorrhea method is effective for the first year postpartum.
• B. You should not use the diaphragm used before your pregnancy.
• C. Apply the transdermal birth control patch on your upper arm.
• D. Avoid using vaginal spermicides while breastfeeding.

Correct answer: D

Rationale: The correct answer is to advise the client to avoid using vaginal spermicides while breastfeeding. This instruction is important as spermicides can potentially affect the milk supply and cause irritation. Choice A is incorrect because the effectiveness of the lactation amenorrhea method diminishes after the first six months postpartum. Choice B is incorrect as using the diaphragm used before pregnancy may not fit properly due to changes in the body postpartum. Choice C is incorrect as the transdermal birth control patch is typically applied to the abdomen, buttocks, or upper torso, not specifically the upper arm.

3. A nurse is caring for an adult client who has prescriptions for multiple medications. Which of the following is an age-related change that increases the risk for adverse effects from these medications?

• A. Rapid gastric emptying
• B. Prolonged medication half-life
• C. Increased medication elimination
• D. Decreased medication sensitivity

Correct answer: B

Rationale: The correct answer is B: Prolonged medication half-life. As clients age, their metabolism tends to slow down, leading to a prolonged half-life of medications in the body. This extended presence of drugs can increase the risk for adverse effects as the substances accumulate. Choice A, rapid gastric emptying, is not an age-related change and actually decreases the time medications spend in the stomach, potentially reducing their effectiveness. Choice C, increased medication elimination, is not an age-related change either; in fact, aging can lead to decreased renal function, affecting drug elimination. Choice D, decreased medication sensitivity, is not an age-related change that directly increases the risk for adverse effects; rather, it may lead to requiring higher doses for effectiveness but does not inherently increase the risk of adverse effects.

4. A patient is 1 day postoperative following a hip arthroplasty. Which of the following actions should the nurse take to prevent dislocation of the hip?

• A. Keep the patient in a side-lying position.
• B. Place a pillow between the patient's legs.
• C. Instruct the patient to avoid sitting for long periods.
• D. Elevate the head of the bed to 90 degrees.

Correct answer: B

Rationale: Placing a pillow between the patient's legs is the correct action to prevent dislocation of the hip following arthroplasty. This technique helps maintain proper alignment and stability of the hip joint. Keeping the patient in a side-lying position may not provide the necessary support to prevent hip dislocation. Instructing the patient to avoid sitting for long periods is important for preventing complications like deep vein thrombosis but does not directly prevent hip dislocation. Elevating the head of the bed to 90 degrees is not relevant to preventing hip dislocation in a postoperative hip arthroplasty patient.

5. A nurse is assessing a client who has chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse report to the provider?

• A. Oxygen saturation of 91%
• B. Use of pursed-lip breathing
• C. Productive cough with green sputum
• D. Decreased breath sounds in the right lower lobe

Correct answer: D

Rationale: The correct finding the nurse should report to the provider is decreased breath sounds in the right lower lobe. This can indicate a respiratory infection or atelectasis in clients with COPD, requiring further evaluation and intervention. Choice A, an oxygen saturation of 91%, although slightly lower than normal, does not necessarily require immediate reporting unless the client's baseline is significantly higher. Choice B, the use of pursed-lip breathing, is actually a beneficial technique for clients with COPD to improve oxygenation and reduce shortness of breath, so it does not need reporting. Choice C, a productive cough with green sputum, can be common in clients with COPD and may indicate an infection, but it is not as concerning as decreased breath sounds in a specific lung lobe which may signify a more acute issue.

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