Nursing Elites

1. The client is recovering from a percutaneous renal biopsy. Which data indicate that the client is complying with client teaching?

• A. The client lies flat in the supine position for 12 hours
• B. The client continues oral fluids restriction while on bed rest
• C. The client’s family changed the dressing on return to the room
• D. The family activates the patient-controlled analgesia pump

Correct answer: A

Rationale: The correct answer is A. Lying flat in the supine position for 12 hours after a renal biopsy helps prevent bleeding, which is crucial for the client's recovery. This position aids in applying pressure to the biopsy site, reducing the risk of bleeding and ensuring optimal healing. Choices B, C, and D do not directly relate to compliance with client teaching after a renal biopsy. Continuing oral fluids restriction, changing the dressing, or activating a patient-controlled analgesia pump are not specific instructions aimed at promoting recovery and preventing complications post renal biopsy.

2. People who use monoamine oxidase inhibitors for the treatment of depression need to avoid foods high in:

• A. Folate
• B. Tyramine
• C. Potassium
• D. Vitamin K

Correct answer: B

Rationale: The correct answer is B: Tyramine. Tyramine can interact with monoamine oxidase inhibitors, leading to hypertensive crises. Folate (choice A) is not contraindicated with monoamine oxidase inhibitors. Potassium (choice C) is an essential mineral and not specifically contraindicated with these medications. Vitamin K (choice D) is not a concern for interactions with monoamine oxidase inhibitors.

3. The nurse is caring for a client whose religious background is Seventh Day Adventist (Church of GOD). Which nursing action(s) are most appropriate in terms of providing for the dietary needs of this client? Select all that apply.

• A. Providing snacks between meals
• B. Removing coffee from the breakfast tray
• C. Ensuring that there is no pork on the dinner tray
• D. A, B

Correct answer: D

Rationale: Seventh Day Adventists typically avoid caffeine and pork, so providing snacks between meals and removing coffee from the breakfast tray are appropriate actions to meet the dietary needs of this client. Providing snacks helps ensure the client has options that align with their dietary restrictions, while removing coffee respects their avoidance of caffeine. Ensuring that there is no pork on the dinner tray is also crucial as pork is typically avoided in their diet, making choice C correct. Therefore, choices A and B are correct, making D the most appropriate selection.

4. The nurse on the postsurgical unit received a client that was transferred from the post-anesthesia care unit (PACU) and is planning care for this client. The nurse understands that staff should begin planning for this client’s discharge at which point during the hospitalization?

• A. Is admitted to the surgical unit
• B. Is transferred from the PACU to the postsurgical unit
• C. Is able to perform activities of daily living independently
• D. Has been assessed by the healthcare provider for the first time after surgery

Correct answer: A

Rationale: Discharge planning should begin as soon as the patient is admitted to the surgical unit to ensure a smooth transition. Option A is the correct choice because it marks the initial point in the hospitalization process where discharge planning should start. Options B, C, and D are not the ideal points to begin discharge planning. Option B only signifies a transfer within the hospital, while Option C relates to the patient's independence in activities of daily living, which is not directly linked to discharge planning. Option D, having the patient assessed by the healthcare provider for the first time after surgery, is unrelated to the timing of discharge planning.

5. Which nursing action(s) can result in disciplinary action by state boards of nursing?

• A. Release of client health information to a client’s neighbor
• B. Delegation of a dressing change to unlicensed assistive personnel (UAP)
• C. Release of client health information to the client’s durable power of attorney
• D. A, B

Correct answer: D

Rationale: The correct answer is D. Disclosing client health information to unauthorized individuals, such as a client's neighbor (choice A) or improper delegation of nursing tasks to unlicensed personnel like UAPs (choice B), are violations of patient confidentiality and safety. Releasing client health information to the client's durable power of attorney (choice C) is a legal and appropriate action, not warranting disciplinary action. Therefore, choices A and B can result in disciplinary action by state boards of nursing, making option D the correct answer.

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