Nursing Elites

1. A nurse is teaching a client who has a new diagnosis of diabetes mellitus about managing blood glucose levels. Which of the following client statements indicates an understanding of the teaching?

• A. "I will monitor my blood pressure regularly."
• B. "I will keep my blood glucose level between 200 and 250 mg/dL."
• C. "I will take my insulin at the same time each day."
• D. "I will eat three large meals each day."

Correct answer: C

Rationale: Taking insulin at the same time each day helps maintain stable blood glucose levels and prevent complications.

2. A nurse is providing dietary teaching to a client with irritable bowel syndrome (IBS). Which dietary recommendation should be included?

• A. Consume food high in bran fiber.
• B. Increase intake of milk products.
• C. Sweeten foods with fructose corn syrup.
• D. Increase foods high in gluten.

Correct answer: A

Rationale: The correct answer is A: Consume food high in bran fiber. Bran fiber helps reduce IBS symptoms by promoting regular bowel movements. Choices B, C, and D are incorrect because increasing milk products can exacerbate symptoms in some individuals with IBS, sweetening foods with fructose corn syrup may worsen symptoms due to its high FODMAP content, and increasing foods high in gluten could be problematic for individuals with gluten sensitivities or celiac disease, which are common in some with IBS.

3. A nurse is assessing a client who has cirrhosis. Which of the following findings should the nurse expect?

• A. Clay-colored stools.
• B. Hypertension.
• C. Stridor.
• D. Elevated temperature.

Correct answer: A

Rationale: Clay-colored stools are a classic finding in a client with cirrhosis. Cirrhosis can lead to impaired bile flow, resulting in pale or clay-colored stools due to a lack of bilirubin in the stool. Hypertension, stridor, and elevated temperature are not typically associated with cirrhosis. Hypertension may occur in cirrhosis but is not a consistent finding, stridor is more commonly associated with upper airway obstruction, and elevated temperature may indicate an infection rather than a direct result of cirrhosis.

4. A nurse is caring for a client who is postoperative following a bowel resection. Which of the following findings should the nurse report to the provider?

• A. Bowel sounds present in all four quadrants
• B. Temperature of 37.5°C (99.5°F)
• C. Scant urine output
• D. Serosanguineous wound drainage

Correct answer: D

Rationale: The correct answer is D: 'Serosanguineous wound drainage.' Serosanguineous drainage should be reported in postoperative clients as it may indicate complications such as infection or impaired wound healing. Options A, B, and C are expected findings in a postoperative client. Bowel sounds present in all four quadrants indicate normal gastrointestinal function, a temperature of 37.5°C (99.5°F) is within the normal range, and scant urine output may be expected initially due to factors like anesthesia and fluid shifts postoperatively.

5. A nurse in a mental health facility is caring for a client who is angry and throwing objects at staff members. Which of the following actions should the nurse take?

• A. Ask the client to identify what made them angry.
• B. Instruct the client to calm down.
• C. Place the client in seclusion.
• D. Encourage the client to attend group therapy.

Correct answer: C

Rationale: During a situation where a client is exhibiting violent behavior like throwing objects and posing a risk to themselves and others, the immediate priority is to ensure the safety of all involved. Placing the client in seclusion is a necessary intervention to prevent harm and allow for de-escalation. Asking the client to identify the trigger or instructing them to calm down may not be effective or safe in this escalated state. Encouraging the client to attend group therapy is not suitable when they are in an agitated and aggressive state that requires immediate intervention.

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