Nursing Elites

1. What dietary alterations should a pregnant client with congenital heart disease expect?

• A. reduced calories and reduced fat
• B. caffeine and sodium restrictions
• C. decreased protein and increased complex carbohydrates
• D. fluid restriction and reduced calories

Correct answer: B

Rationale: In a pregnant client with congenital heart disease, caffeine should be restricted as it can increase heart rate, which is already under stress due to pregnancy. Sodium restrictions may be necessary to prevent fluid retention, which can worsen the client's heart condition. Decreasing calories, fat, protein, or fluid may not be appropriate as these can lead to nutrient deficiencies or inadequate energy intake, which is crucial during pregnancy. Therefore, options A, C, and D are not the expected dietary alterations in the client's diet during pregnancy with congenital heart disease.

2. A young boy is recently diagnosed with a seizure disorder. Which of the following statements by the boy's mother indicates a need for further teaching by the nurse?

• A. "I should make sure he gets plenty of rest."?
• B. "I should get him a medical alert bracelet."?
• C. "I should lay him on his back during a seizure."?
• D. "I should loosen his clothing during a seizure."?

Correct answer: C

Rationale: The correct answer is '"I should lay him on his back during a seizure."?' When a client is having a seizure, it is crucial to turn them onto their side to prevent aspiration of secretions. Placing them on their back can lead to potential airway compromise. Choices A, B, and D are correct statements that indicate a good understanding of caring for a child with a seizure disorder: ensuring rest, getting a medical alert bracelet for identification, and loosening clothing to facilitate breathing during a seizure.

3. A client being treated for sickle cell disease has an order for pain medication. Morphine was ordered, but the nurse is having difficulty deciphering the dose. The nurse should ____.

• A. ask the attending physician to clarify the order, including the correct medication, dose, route, and frequency
• B. call the charge nurse to inform the attending physician and verify the order, including the correct medication, dose, route, and frequency
• C. call the attending physician to verbally verify the order, including the correct medication, dose, route, and frequency
• D. refrain from administering the medication until the charge nurse can assist in determining the correct dosage

Correct answer: C

Rationale: In this scenario, when a nurse encounters difficulties in deciphering an order, the appropriate action is to contact the attending physician directly to clarify and verify the medication, dose, route, and frequency. It is crucial for the nurse to have a clear understanding of the order before administering any medication to ensure patient safety and proper treatment. Option A is incorrect as it suggests asking the attending physician to clarify without specifying the urgency of the situation. Option B involves an unnecessary additional step by first contacting the charge nurse before reaching out to the attending physician, potentially delaying the clarification process. Option D is incorrect as it advises refraining from administering the medication, which may not be necessary if the correct dosage can be promptly verified by contacting the attending physician.

4. An 85-year-old client is eligible for Medicare-reimbursable home care services. Referral is contingent on meeting which of the following criteria?

• A. homebound status, requiring skilled therapy care
• B. immediate previous hospitalization for acute care
• C. age
• D. requirement of nursing and social work support

Correct answer: A

Rationale: The correct criteria for Medicare-reimbursable home care services include the client being homebound and requiring a skilled service, such as physical therapy, occupational therapy, speech therapy, nursing, or social work. Choice A is correct because it aligns with these requirements. Choice B is incorrect as immediate previous hospitalization is not a prerequisite for home care services. Choice C is incorrect as age alone does not determine eligibility for Medicare-reimbursable home care services. Choice D is incorrect as the requirement of nursing and social work support alone is not sufficient for Medicare-reimbursable home care services.

5. A client has signed the informed consent for mastectomy of the left breast. On the morning of the surgical procedure, the client asks the nurse several questions about the procedure that make it obvious that she does not have an adequate comprehension of the procedure. What is the most appropriate response by the nurse?

• A. Telling the client that she needed to ask these questions before signing the informed consent for surgery
• B. Contacting the surgeon and requesting that she visit the client to answer her questions
• C. Informing the client that she has the right to cancel the surgical procedure if she wishes
• D. Telling the client that it is her surgeon's responsibility to explain the procedure

Correct answer: B

Rationale: Informed consent is the authorization by a client or a client's legal representative to do something to the client. The surgeon is primarily responsible for explaining the surgical procedure and obtaining informed consent. If the client asks questions that alert the nurse to an inadequacy of comprehension on the client's part, the nurse has the obligation to contact the surgeon. Choice A is incorrect as the client should be allowed to ask questions even after signing the consent for surgery. Choice C is not the most appropriate response, as the primary concern is to address the client's lack of comprehension. Choice D is inaccurate, as while it is the surgeon's responsibility to explain the procedure, in this scenario, the nurse should take immediate action to ensure the client's understanding. Requesting the surgeon to visit and answer the client's questions is the most appropriate response in this situation, as it directly addresses the client's concerns and ensures proper informed consent is obtained.

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