Nursing Elites

1. The client with ulcerative colitis calls the clinic and reports increasing abdominal pain and increased frequency of loose stools. He asks to clarify what type of diet he is to follow. Which diet is best for clients with ulcerative colitis?

• A. High vitamin
• B. High calorie
• C. Low sugar
• D. Low fiber

Correct answer: D

Rationale: The correct answer is 'Low fiber.' Clients with ulcerative colitis should follow a low-residue diet, which means consuming low fiber to reduce the frequency and volume of stools, helping to alleviate symptoms such as abdominal pain and diarrhea. High fiber diets can worsen the condition by stimulating bowel movements. Choice A, 'High vitamin,' is incorrect as the focus is on fiber content rather than vitamins. Choice B, 'High calorie,' is not specifically recommended for ulcerative colitis and may not address the symptoms effectively. Choice C, 'Low sugar,' does not directly address the dietary needs of clients with ulcerative colitis as the issue is more related to fiber intake than sugar consumption.

2. The client asked about the role of leptin in the body. Which response should the nurse provide?

• A. It increases food intake in clients, thereby promoting obesity.
• B. It assists in the regulation of steroids.
• C. It increases the total fat mass of people who are obese.
• D. It might decrease the total fat mass in the bodies of people who are obese.

Correct answer: D

Rationale: Leptin is a protein hormone expressed in fat cells that regulates fat cell percentage in the body. It is associated with increased energy expenditure and decreased food intake through hypothalamic control. In obese individuals, there may be insensitivity or resistance to leptin's effects. Leptin influences other hormones like insulin and genetic factors related to fat regulation. Therefore, the correct response is that leptin might decrease total fat mass in obese individuals as it is involved in energy balance and fat regulation. Choices A, B, and C are incorrect because leptin does not increase food intake or promote obesity; it does not assist in the regulation of steroids, and it does not increase total fat mass in people who are obese.

3. A mother of a newborn notices a nurse placing liquid in her baby's eyes. Which of the following is an inaccurate statement about the need for eyedrops following birth?

• A. Eyedrops following birth help reduce the risk of eye infection.
• B. Eyedrops are required by law.
• C. Eyedrops will keep the eye moist.
• D. Eyedrops are required by law every 6 hours following birth.

Correct answer: D

Rationale: The correct answer is 'Eyedrops are required by law every 6 hours following birth.' This statement is inaccurate because while laws do require the placement of eyedrops, physicians indicate a specific timeframe for their administration. Choice A is correct because eyedrops following birth do help reduce the risk of eye infection by preventing ophthalmia neonatorum. Choice B is incorrect as it implies that eyedrops are mandated solely by law, without considering medical reasons. Choice C is accurate as eyedrops do help keep the eye moist, preventing dryness and discomfort.

4. Which is an example of a sentinel event?

• A. The terminally ill client is referred to hospice and dies 3 months later.
• B. A client receives an unordered mammogram which reveals a small cyst.
• C. A client with a laceration to the knee requiring 4 sutures falls when getting up unassisted after being instructed to remain in bed.
• D. A client scheduled for knee replacement surgery had an above-the-knee amputation performed.

Correct answer: D

Rationale: Yes! A sentinel event is an unexpected occurrence causing death or serious injury. In this case, a client who was scheduled for knee replacement surgery but had an above-the-knee amputation performed instead represents a sentinel event as it resulted in serious harm that was not intended. The other choices do not meet the criteria for a sentinel event. Choice A describes a natural progression for a terminally ill client, choice B shows an incidental finding from a test, and choice C involves a preventable fall leading to an injury but not a sentinel event.

5. A client is admitted for observation following an unrestrained motor vehicle accident. A bystander stated that he lost consciousness for 1-2 minutes. On admission, the client's Glasgow Coma Scale (GCS) was 14. The GCS is now 12. The nurse should:

• A. Re-assess in 15 minutes
• B. Stimulate the client with a sternal rub
• C. Administer Tylenol with codeine for a headache
• D. Notify the physician

Correct answer: D

Rationale: A decrease in the Glasgow Coma Scale (GCS) score from 14 to 12 indicates a significant neurological change in the client's condition. This change can be indicative of a deterioration in the client's neurological status, possibly due to intracranial bleeding or swelling. It is crucial for the nurse to notify the physician immediately to ensure prompt evaluation and intervention. Re-assessing in 15 minutes or stimulating the client with a sternal rub are not appropriate actions in this situation as they do not address the underlying cause of the decrease in GCS. Administering Tylenol with codeine for a headache is also not recommended without further assessment and evaluation of the client's condition.

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