Nursing Elites

1. A client with osteoporosis is being taught about dietary management. Which statement indicates an understanding of the teaching?

• A. I should increase my intake of foods high in vitamin D.
• B. I should decrease my intake of foods high in calcium.
• C. I should increase my intake of foods high in phosphorus.
• D. I should decrease my intake of foods high in potassium.

Correct answer: A

Rationale: The correct answer is A. Increasing intake of foods high in vitamin D is beneficial for improving calcium absorption and managing osteoporosis. Vitamin D helps the body absorb calcium, which is essential for bone health and can aid in managing osteoporosis effectively. Choice B is incorrect because reducing calcium intake would be counterproductive for a client with osteoporosis, as calcium is crucial for bone strength. Choice C is incorrect as phosphorus, while important for bone health, does not directly impact osteoporosis management as much as vitamin D and calcium. Choice D is incorrect as potassium is not directly linked to osteoporosis management, and reducing its intake is not typically part of dietary recommendations for osteoporosis.

2. A healthcare professional is preparing to administer a subcutaneous injection of insulin. Which of the following actions should the professional take?

• A. Use a 1-inch needle.
• B. Insert the needle at a 90-degree angle.
• C. Use a tuberculin syringe.
• D. Aspirate before injecting.

Correct answer: B

Rationale: When administering a subcutaneous injection, inserting the needle at a 90-degree angle is appropriate. This angle helps ensure proper delivery of the medication into the subcutaneous tissue. Using a 1-inch needle is common for subcutaneous injections to reach the subcutaneous fat layer adequately. Tuberculin syringes are typically used for intradermal injections, not subcutaneous injections. Aspirating before injecting is not necessary for subcutaneous injections as it is primarily used for intramuscular injections to ensure the needle is not in a blood vessel.

3. A client has a stage 1 pressure ulcer on the right heel. Which of the following interventions should the nurse include in the plan?

• A. Apply a heat lamp to the area for 20 minutes each day.
• B. Change the dressing on the heel every 12 hours.
• C. Apply a transparent dressing over the heel.
• D. Use a water pressure mattress.

Correct answer: C

Rationale: Applying a transparent dressing over the heel is beneficial as it can protect the ulcer from friction and shear, and allow for continuous observation of the wound. This intervention promotes healing and prevents further damage to the skin. Choice A is incorrect because applying heat can increase the risk of tissue damage and should be avoided. Choice B is incorrect as changing the dressing every 12 hours may disrupt the wound healing process and is not necessary for a stage 1 pressure ulcer. Choice D is incorrect because using a water pressure mattress is not a specific intervention for a stage 1 pressure ulcer on the heel.

4. Following a total hip arthroplasty, what intervention should the healthcare provider implement for the client?

• A. Place a pillow between the client's legs.
• B. Elevate the head of the bed to 45 degrees.
• C. Position the client on the operative side.
• D. Keep the client’s legs adducted.

Correct answer: A

Rationale: Placing a pillow between the client's legs is crucial post hip arthroplasty surgery to prevent hip dislocation. This intervention helps maintain proper alignment and prevents legs from crossing midline, reducing the risk of hip prosthesis dislocation. Elevating the head of the bed to 45 degrees, positioning the client on the operative side, or keeping the client's legs adducted are not recommended postoperative interventions for a total hip arthroplasty, as they can increase the risk of complications and compromise the surgical site.

5. A client is receiving enteral feedings through an NG tube. Which of the following actions should be taken to prevent aspiration?

• A. Monitor gastric residuals every 4 hours.
• B. Position the client in a semi-Fowler's position.
• C. Check for tube placement by auscultating air after feeding.
• D. Warm the formula to body temperature before feeding.

Correct answer: A

Rationale: Monitoring gastric residuals every 4 hours is essential to assess the stomach's ability to empty properly, reducing the risk of aspiration. It helps in determining if the feedings are being tolerated by the client and if adjustments are needed in the feeding regimen. Positioning the client in a semi-Fowler's position helps prevent reflux and aspiration by promoting proper digestion and emptying of the stomach contents. Checking for tube placement by auscultating air after feeding confirms correct tube placement in the stomach. Warming the formula to body temperature before feeding enhances client comfort but does not directly prevent aspiration. Therefore, the correct answer is to monitor gastric residuals to prevent aspiration, as it directly assesses the stomach's ability to empty properly and the tolerance of the feedings.

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