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 is being assessed in the PACU. Which of the following findings indicates decreased cardiac output?

• A. Shivering
• B. Oliguria
• C. Bradypnea
• D. Constricted pupils

Correct answer: B

Rationale: Oliguria is a sign of decreased cardiac output. Decreased cardiac output can lead to poor renal perfusion, resulting in decreased urine output (oliguria). This requires immediate intervention to improve cardiac function and perfusion. Shivering (Choice A) is a response to cold stress and does not directly indicate decreased cardiac output. Bradypnea (Choice C) refers to abnormally slow breathing rate and is more indicative of respiratory issues rather than decreased cardiac output. Constricted pupils (Choice D) are associated with the parasympathetic nervous system response and not directly related to cardiac output.

3. A nurse is caring for a client who has a new prescription for warfarin. Which of the following laboratory tests should the nurse use to monitor the client's therapeutic response to the medication?

• A. INR
• B. aPTT
• C. Platelet count
• D. Hemoglobin A1C

Correct answer: A

Rationale: The correct answer is A: INR. The INR (International Normalized Ratio) is the laboratory test used to monitor the therapeutic response of warfarin. It helps ensure that the client's clotting time is within the desired range to prevent complications such as excessive bleeding or clotting. Choice B, aPTT (Activated Partial Thromboplastin Time), is not typically used to monitor warfarin therapy but rather for assessing heparin therapy. Choice C, Platelet count, assesses the number of platelets in the blood and is not specifically used to monitor warfarin therapy. Choice D, Hemoglobin A1C, is a test used to monitor long-term blood sugar control in diabetic patients and is not relevant to monitoring warfarin therapy.

4. A nurse is caring for a client who is receiving enteral nutrition through a nasogastric tube. Which of the following actions should the nurse take?

• A. Flush the tube with 30 mL of sterile water before each feeding
• B. Administer the feeding using a large-bore syringe
• C. Keep the head of the bed elevated to 15 degrees
• D. Replace the feeding bag every 24 hours

Correct answer: A

Rationale: The correct action for the nurse to take is to flush the tube with 30 mL of sterile water before each feeding. This helps maintain tube patency and prevents clogs. Choice B is incorrect because enteral feedings should be administered using a gravity drip method or a pump, not through a large-bore syringe. Choice C is incorrect because the head of the bed should be elevated to at least 30 degrees to reduce the risk of aspiration. Choice D is incorrect because the feeding bag should be replaced every 24 hours to prevent bacterial contamination.

5. A nurse overhears two assistive personnel (AP) discussing a client in an elevator. What action should the nurse take?

• A. Contact the client's family about the incident.
• B. Notify the client's provider about the incident.
• C. File a complaint with the facility's ethics committee.
• D. Report the incident to the AP's charge nurse.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to report the incident to the AP's charge nurse. This is important because discussing a client's information violates confidentiality policies. Contacting the client's family (Choice A) is not appropriate as it may breach confidentiality further. Notifying the client's provider (Choice B) is not the initial action to take in this situation, as addressing it within the facility should come first. Filing a complaint with the facility's ethics committee (Choice C) is not the immediate step and might not directly address the issue at hand.

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