Nursing Elites

1. A client with cardiovascular disease is being taught by a nurse how to reduce sodium and cholesterol intake. The nurse understands that the most significant factor in planning dietary changes for this client is:

• A. Client’s financial resources
• B. Involvement of the client in planning the change
• C. Availability of low-sodium foods
• D. Frequency of dietary counseling sessions

Correct answer: B

Rationale: The most significant factor in planning dietary changes for a client with cardiovascular disease is the involvement of the client in planning the change. By involving the client in the planning process, the nurse ensures that the client takes ownership of their health and is more likely to adhere to and succeed in modifying dietary habits. This empowerment and engagement enhance the client's motivation and commitment to making sustainable changes. Financial resources, availability of low-sodium foods, and frequency of dietary counseling sessions are important considerations but are not as crucial as the client's active involvement in the planning process.

2. A client is postoperative following knee arthroplasty and requires the use of a thigh-length sequential compression device. Which of the following actions should the nurse take?

• A. Ensure two fingers can fit under the sleeves.
• B. Ensure the device is not too tight to impede circulation.
• C. Position the client comfortably before applying the device.
• D. Use the device continuously to prevent blood clots.

Correct answer: A

Rationale: The correct action for the nurse to take when applying a thigh-length sequential compression device to a postoperative client is to ensure that two fingers can fit under the sleeves. This action helps prevent the device from being too tight, which could impede circulation. Choice B is incorrect because the device should not be too tight, as it could lead to circulation issues. Choice C is incorrect as the client should be in a comfortable position, not necessarily supine. Choice D is incorrect as sequential compression devices are typically used continuously to prevent blood clots.

3. The nurse is providing oral care to a patient. In which order will the nurse clean the oral cavity, starting with the first area?

• A. Roof of mouth, gums, and inside cheeks
• B. Chewing and inner tooth surfaces
• C. Outer tooth surfaces
• D. Tongue

Correct answer: C

Rationale: The correct sequence for oral care is to clean the outer tooth surfaces first, followed by cleaning the inner tooth surfaces, then the roof of the mouth, gums, and inside cheeks with a toothette. Brushing the tongue should be the final step in the oral care procedure. Therefore, option C is the correct choice. Options A, B, and D are incorrect because they do not follow the correct order for providing oral care to a patient.

4. A client is receiving teaching from a healthcare provider about reducing the adverse effects of immobility. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will perform ankle and knee exercises every hour - Range of motion (ROM) is needed to prevent contractures.
• B. I will hold my breath when rising from a sitting position.
• C. I will remove my antiembolic stockings while I am in bed.
• D. I will have my partner help me change positions every 4 hours.

Correct answer: A

Rationale: Choice A is correct because performing ankle and knee exercises every hour helps prevent contractures and other adverse effects of immobility. Contractures are a common complication of immobility, and range of motion (ROM) exercises can help maintain joint flexibility and prevent contractures. This statement indicates an understanding of the teaching provided by the healthcare provider. Choices B, C, and D are incorrect. Holding the breath when rising from a sitting position can increase the risk of orthostatic hypotension, not reduce adverse effects of immobility. Removing antiembolic stockings while in bed can compromise their effectiveness in preventing deep vein thrombosis (DVT), which is not a measure to reduce immobility-related complications. Having a partner help change positions every 4 hours may not be frequent enough to prevent immobility-related complications effectively; changing positions more frequently is usually recommended to prevent issues like pressure ulcers and muscle stiffness.

5. A client in a provider’s office tells the nurse that, 'I fast for several days each week to help control my weight.' The client takes several medications for various chronic issues. The nurse should explain to the client that which of the following mechanisms that result from fasting puts her at risk for medication toxicity?

• A. Increasing the metabolism of the medications over time
• B. Increasing the protein-binding response
• C. Increasing medications’ transit time through the intestines
• D. Decreasing the excretion of medications

Correct answer: B

Rationale: Fasting can lead to an increased protein-binding response of medications. This can result in a higher concentration of bound medications in the bloodstream, potentially causing toxicity as the medications may not be readily available for metabolism or excretion. Choice A is incorrect because fasting typically doesn't increase medication metabolism. Choice C is incorrect as fasting usually decreases transit time through the intestines. Choice D is incorrect since fasting generally does not decrease medication excretion.

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