Nursing Elites

1. A client with lactose intolerance and has eliminated dairy products from his diet should increase consumption of which of the following foods?

• A. Spinach
• B. Peanut butter
• C. Ground beef
• D. Carrots

Correct answer: A

Rationale: Spinach is the correct answer because it is a good source of calcium. Since the client has eliminated dairy products due to lactose intolerance, which are a common source of calcium, increasing spinach consumption can help compensate for the lost calcium. Peanut butter, ground beef, and carrots are not significant sources of calcium and therefore not the best choice for this client.

2. A nurse is assessing a newborn who is 1-day old and receiving phototherapy for jaundice. Which action should the nurse take?

• A. Feed the infant glucose water every 2 hours.
• B. Ensure the newborn wears a diaper.
• C. Keep the infant's head covered with a cap.
• D. Apply lotion to the newborn every 4 hours.

Correct answer: C

Rationale: The correct action for the nurse to take is to keep the infant's head covered with a cap. This helps regulate the newborn's body temperature during phototherapy. Option A, feeding the infant glucose water every 2 hours, is incorrect because it is not a standard intervention for newborns receiving phototherapy. Option B, ensuring the newborn wears a diaper, may be necessary for hygiene but is not directly related to phototherapy. Option D, applying lotion to the newborn every 4 hours, is unnecessary and not indicated for managing jaundice or phototherapy.

3. 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.

4. A nurse is caring for a client who has a urinary tract infection (UTI) and is prescribed ciprofloxacin. The nurse should instruct the client to monitor for and report which of the following adverse effects?

• A. Tinnitus.
• B. Photosensitivity.
• C. Urinary frequency.
• D. Insomnia.

Correct answer: B

Rationale: The correct answer is B: Photosensitivity. Ciprofloxacin, an antibiotic commonly used to treat UTIs, can cause photosensitivity as an adverse effect. This reaction makes the skin more sensitive to sunlight, potentially leading to severe sunburns or skin damage. It is crucial for the client to be aware of this adverse effect to take precautions and report any signs of photosensitivity promptly. Choices A, C, and D are incorrect because tinnitus, urinary frequency, and insomnia are not typically associated with ciprofloxacin use. While urinary frequency might be a symptom of UTI, it is not an adverse effect of the medication itself.

5. A charge nurse is teaching a group of nurses about the correct use of restraints. Which of the following should the nurse include in the teaching?

• A. Place a belt restraint on a school-age child who has seizures.
• B. Secure wrist restraints to the bed rails for an adolescent.
• C. Apply elbow immobilizers to an infant with a cleft lip injury.
• D. Keep the side rails of a toddler's crib elevated.

Correct answer: D

Rationale: The correct use of restraints is crucial to ensure patient safety. Keeping the side rails of a toddler's crib elevated is a safe practice as it prevents falls and provides a level of protection without directly restraining the child. Placing a belt restraint on a child with seizures (Choice A) is inappropriate as it may restrict movement and cause harm during a seizure. Securing wrist restraints to bed rails for an adolescent (Choice B) is not recommended as it can lead to injuries and compromise circulation. Applying elbow immobilizers to an infant with a cleft lip injury (Choice C) is also incorrect as it does not address the issue of restraint and is not a standard practice in this situation.

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