Nursing Elites

1. A client with gastroesophageal reflux disease (GERD) is being taught about lifestyle changes to manage the condition. Which of the following instructions should the nurse include?

• A. Avoid eating small, frequent meals.
• B. Sleep with the head of your bed elevated.
• C. Lie down after eating.
• D. Avoid drinking fluids with meals.

Correct answer: B

Rationale: The correct answer is B: 'Sleep with the head of your bed elevated.' Elevating the head of the bed helps reduce acid reflux by keeping the head higher than the stomach, preventing stomach acid from flowing back into the esophagus. Choices A, C, and D are incorrect. Avoiding eating small, frequent meals, lying down after eating, and drinking fluids with meals can exacerbate GERD symptoms by increasing stomach acid production and promoting acid reflux.

2. A patient refused a newly open fentanyl patch. Which of the following actions should the nurse take?

• A. Ask another nurse to witness the disposal of the new patch
• B. Dispose of the patch in a sharps container
• C. Send the patch back to the pharmacy
• D. Document the refusal and remove the patch

Correct answer: A

Rationale: The correct action for the nurse to take when a patient refuses a newly open fentanyl patch is to ask another nurse to witness the disposal of the new patch. This is essential for accountability and ensuring proper disposal procedures are followed. Choice B is incorrect because disposing of the patch in a sharps container without a witness does not ensure proper accountability. Choice C is incorrect as sending the patch back to the pharmacy is not the appropriate action for disposal. Choice D is incorrect because although documenting the refusal is important, it is also crucial to ensure proper disposal of the unused patch by having another nurse witness it.

3. A nurse is caring for a client who is at risk for developing pressure ulcers. Which of the following interventions should the nurse implement?

• A. Use a donut-shaped cushion for sitting
• B. Turn the client every 4 hours
• C. Elevate the head of the bed to 45 degrees
• D. Massage reddened areas to increase circulation

Correct answer: C

Rationale: Elevating the head of the bed reduces pressure on bony prominences, which helps prevent pressure ulcers.

4. A nurse is caring for a client who has cirrhosis. Which of the following laboratory values should the nurse expect to be decreased?

• A. Bilirubin.
• B. Albumin.
• C. Ammonia.
• D. Prothrombin time.

Correct answer: B

Rationale: In clients with cirrhosis, albumin levels are typically decreased due to impaired liver function. Bilirubin levels are often increased in cirrhosis due to the liver's inability to process bilirubin efficiently. Ammonia levels may be elevated in cirrhosis due to impaired ammonia metabolism by the liver. Prothrombin time is usually prolonged in cirrhosis because the liver's ability to synthesize clotting factors is impaired.

5. A nurse working in a rehabilitation facility is developing a discharge plan for a client who has left-sided hemiplegia. Which of the following actions is the nurse's priority?

• A. Consult with a case manager regarding insurance coverage.
• B. Counsel caregivers on respite care options.
• C. Ensure that the client has a referral for physical therapy.
• D. Refer the client to a local stroke support group.

Correct answer: C

Rationale: The correct answer is C: 'Ensure that the client has a referral for physical therapy.' For a client with left-sided hemiplegia, physical therapy is crucial in restoring function and mobility. It is the nurse's priority to ensure the client receives the necessary rehabilitation services. Consulting with a case manager about insurance coverage (Choice A) is important but not the priority at this stage. Counseling caregivers on respite care options (Choice B) and referring the client to a local stroke support group (Choice D) are also valuable but not as essential as ensuring the client has access to physical therapy for rehabilitation.

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