Nursing Elites

1. A client with gastroesophageal reflux disease (GERD) is being taught about lifestyle modifications. Which of the following instructions should be included?

• A. Sleep with the head of the bed elevated.
• B. Avoid drinking fluids with meals.
• C. Eat three large meals each day.
• D. Lie down after eating.

Correct answer: B

Rationale: The correct instruction for a client with GERD is to avoid drinking fluids with meals. This is because consuming fluids while eating can exacerbate reflux symptoms by increasing stomach distension and contributing to the reflux of stomach contents into the esophagus. Option A is incorrect as elevating the head of the bed can help prevent reflux during sleep, not while drinking fluids. Option C is incorrect as consuming three large meals a day can worsen GERD symptoms due to increased gastric distension. Option D is incorrect as lying down after eating can also worsen GERD symptoms by promoting the reflux of stomach contents into the esophagus.

2. A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following findings should the nurse identify as a manifestation of digoxin toxicity?

• A. Constipation.
• B. Tachycardia.
• C. Visual disturbances.
• D. Hypertension.

Correct answer: C

Rationale: Visual disturbances, such as blurred or yellow vision, are common signs of digoxin toxicity. While constipation (Choice A) is not typically associated with digoxin toxicity, tachycardia (Choice B) and hypertension (Choice D) are not characteristic manifestations of digoxin toxicity. Therefore, the correct answer is visual disturbances (Choice C).

3. A client at risk for osteoporosis is receiving teaching from a nurse. Which of the following client statements indicates an understanding of the teaching?

• A. I will avoid weight-bearing exercises.
• B. I should increase my intake of vitamin D.
• C. I should reduce my intake of dairy products.
• D. I will increase my intake of foods high in calcium.

Correct answer: B

Rationale: The correct answer is B: 'I should increase my intake of vitamin D.' Adequate vitamin D intake is crucial for calcium absorption, which is essential for bone health and preventing osteoporosis. Avoiding weight-bearing exercises (choice A) would be detrimental as weight-bearing activities help improve bone density. Reducing dairy intake (choice C) is not recommended as dairy products are a good source of calcium. While increasing calcium intake (choice D) is important, ensuring sufficient vitamin D levels for proper absorption is equally crucial for bone health.

4. A nurse has just received change-of-shift report for four clients. Which of the following clients should the nurse assess first?

• A. A client who was just given a glass of orange juice for a low blood glucose level.
• B. A client who is scheduled for a procedure in 1 hr.
• C. A client who has 100 mL of fluid remaining in his IV bag.
• D. A client who received a pain medication 30 min ago for postoperative pain.

Correct answer: A

Rationale: A client with low blood glucose levels needs immediate assessment to ensure stabilization. Hypoglycemia can lead to serious complications if not addressed promptly. The other options do not present immediate life-threatening situations that require urgent assessment. Option B can be attended to after addressing the client with low blood glucose levels. Option C can be managed based on the infusion rate and the client's condition. Option D, although important, can be assessed after ensuring the client with low blood glucose levels is stable.

5. A nurse is preparing to administer a dose of digoxin to a client who has heart failure. Which of the following actions should the nurse take prior to administering the medication?

• A. Monitor the client's respiratory rate.
• B. Assess the client's apical pulse.
• C. Review the client's potassium level.
• D. Monitor the client's fluid intake.

Correct answer: B

Rationale: The correct action the nurse should take prior to administering digoxin is to assess the client's apical pulse. Digoxin is known to affect the heart rate, potentially causing bradycardia. Monitoring the client's respiratory rate (Choice A) is not directly related to administering digoxin. Reviewing the client's potassium level (Choice C) is important but not a direct prerequisite for administering digoxin. Monitoring the client's fluid intake (Choice D) is also important but not a specific action to take just before administering digoxin.

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