Nursing Elites

1. A nurse is reinforcing teaching with a client who has COPD. Which of the following instructions by the nurse is appropriate?

• A. Drink carbonated beverages.
• B. Decrease fiber intake.
• C. Use bronchodilators after meals.
• D. Increase protein intake.

Correct answer: D

Rationale: The correct answer is to instruct the client to increase protein intake. This is appropriate because increasing protein intake can help maintain muscle mass and strength in clients with COPD. Option A, 'Drink carbonated beverages,' is incorrect as carbonated beverages can exacerbate COPD symptoms. Option B, 'Decrease fiber intake,' is also incorrect as fiber is important for digestion and should not be decreased unless specifically advised by a healthcare provider. Option C, 'Use bronchodilators after meals,' is incorrect because bronchodilators are typically used before meals to help open the airways for better breathing, not after meals.

2. A 14-year-old with a history of sickle cell disease is admitted to the hospital with a diagnosis of vaso-occlusive crisis. Which statement by the client would be most indicative of the etiology of this crisis?

• A. I knew this would happen. I've been eating too much red meat lately.
• B. I really enjoyed my fishing trip yesterday. I caught 2 fish.
• C. I have really been working hard practicing with the debate team at school.
• D. I went to the healthcare provider last week for a cold, and I have gotten worse.

Correct answer: D

Rationale: The correct answer is D because a recent illness, such as a cold, can trigger a vaso-occlusive crisis in sickle cell disease. This crisis is often precipitated by infections or other illnesses that cause a systemic inflammatory response, leading to vaso-occlusion. Choices A, B, and C do not directly relate to the etiology of a vaso-occlusive crisis in sickle cell disease, making them incorrect.

3. After a client has an enteral feeding tube inserted, the most accurate method for verification of placement is

• A. Abdominal x-ray
• B. Auscultation
• C. Flushing tube with saline
• D. Aspiration for gastric contents

Correct answer: D

Rationale: After the insertion of an enteral feeding tube, the most accurate method for verifying its placement is by aspirating gastric contents. This method ensures that the tube is correctly positioned in the stomach. Abdominal x-ray can provide additional confirmation but is not as immediate or practical. Auscultation and flushing the tube with saline are not as reliable as aspirating gastric contents for verifying proper placement of an enteral feeding tube.

4. The client is being taught to select foods rich in potassium to help prevent digitalis toxicity. Which choice indicates the client understands dietary needs?

• A. Three apricots
• B. Medium banana
• C. Naval orange
• D. Baked potato

Correct answer: D

Rationale: The correct answer is D. A baked potato is high in potassium and helps prevent digitalis toxicity by maintaining adequate potassium levels. While choices A, B, and C all contain some potassium, a baked potato is a more concentrated source of potassium compared to three apricots, a medium banana, or a naval orange. Therefore, the client should choose a baked potato to better meet the dietary needs for preventing digitalis toxicity.

5. A client with gastroesophageal reflux is receiving teaching from a nurse. Which statement by the client indicates a need for further teaching?

• A. I will avoid eating after supper.
• B. I can drink coffee throughout the day.
• C. I drink milk when I get heartburn.
• D. I should not eat foods made with chocolate.

Correct answer: B

Rationale: The correct answer is B. Drinking coffee throughout the day can aggravate gastroesophageal reflux symptoms. Choices A, C, and D are correct statements that can help manage gastroesophageal reflux by avoiding late-night eating, not consuming trigger foods like chocolate, and using milk for relief when experiencing heartburn.

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