Nursing Elites

1. A client is being taught about which foods to include in a low fiber diet. Which statement indicates understanding?

• A. Choosing a fresh pear would be a good snack option
• B. I should make refried beans for supper
• C. Selecting white rice as a side dish is a good choice
• D. Opting for bran cereal would be a good breakfast choice

Correct answer: C

Rationale: The correct answer is C because white rice is a low-fiber food suitable for a low-fiber diet, making it an appropriate choice. Choices A, B, and D are incorrect because fresh pear, refried beans, and bran cereal are high-fiber foods and not suitable for a low-fiber diet.

2. A nurse is preparing to administer aspirin 650mg PO every 12 hr. The amount available is aspirin 325mg tablets. How many tablets should the nurse administer?

• A. 1 tablet
• B. 2 tablets
• C. 3 tablets
• D. 4 tablets

Correct answer: B

Rationale: The correct answer is 2 tablets. Each tablet of aspirin is 325mg. To achieve the required dose of 650mg, the nurse should administer 2 tablets. Choice A (1 tablet) is incorrect because it would only provide 325mg, which is half the required dose. Choices C (3 tablets) and D (4 tablets) are incorrect as they would exceed the required dose.

3. A nurse is caring for a patient who has just returned from surgery. What is the nurse's priority action?

• A. Monitor the patient's pain level.
• B. Assess the patient's vital signs.
• C. Assess the surgical incision site.
• D. Position the patient in a high Fowler's position.

Correct answer: B

Rationale: The correct answer is B: Assess the patient's vital signs. Assessing vital signs is crucial as it helps to detect any early signs of complications such as bleeding, shock, or changes in oxygenation. Monitoring the patient's pain level (Choice A) is important but assessing vital signs takes precedence. While assessing the surgical incision site (Choice C) is essential, ensuring the patient's physiological stability through vital sign assessment is the priority. Positioning the patient in a high Fowler's position (Choice D) may be necessary for comfort but does not address the immediate need to assess the patient's condition post-surgery.

4. What are the clinical manifestations of hypovolemic shock, and how should a nurse respond?

• A. Hypertension, bradycardia, and oliguria
• B. Bradycardia, hypertension, and peripheral edema
• C. Tachypnea, cool skin, and confusion
• D. Tachycardia, hypotension, and decreased urine output

Correct answer: D

Rationale: The correct answer is D: Tachycardia, hypotension, and decreased urine output are classic clinical manifestations of hypovolemic shock. In hypovolemic shock, the body tries to compensate for low blood volume by increasing the heart rate (tachycardia) to maintain cardiac output, leading to hypotension and decreased urine output. Prompt fluid replacement is necessary to restore intravascular volume. Choices A, B, and C are incorrect because they do not represent the typical manifestations of hypovolemic shock.

5. Which goal is most appropriate for a patient who has had a total hip replacement?

• A. The nurse will assist the patient in ambulating in the hall 2 times a day.
• B. The patient will walk 100 feet using a walker by the time of discharge.
• C. The patient will ambulate briskly on the treadmill by the time of discharge.
• D. The patient will ambulate independently by the time of discharge.

Correct answer: B

Rationale: Choice B is the most appropriate goal for a patient who has had a total hip replacement because it is specific, measurable, and achievable. Walking 100 feet using a walker is a realistic and individualized target for a patient in the recovery phase following hip surgery. Choices A, C, and D are not as suitable: Choice A does not specify a measurable distance or objective, Choice C sets a potentially unrealistic expectation for brisk ambulation on a treadmill, and Choice D lacks the specificity of the distance to be walked.

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