Nursing Elites

1. The nurse is providing discharge teaching to a client with a new diagnosis of diabetes mellitus. Which statement by the client indicates a need for further teaching?

• A. I will need to monitor my blood sugar levels daily.
• B. I will follow a diet low in carbohydrates.
• C. I will rotate the injection sites for my insulin.
• D. I will exercise regularly to help manage my diabetes.

Correct answer: B

Rationale: The correct answer is B. The statement 'I will follow a diet low in carbohydrates' indicates a need for further teaching. In diabetes mellitus, it is essential to follow a balanced diet that includes carbohydrates, proteins, and fats. Carbohydrates are a major source of energy and should be included in moderation to help manage blood sugar levels. Monitoring blood sugar levels daily (A), rotating injection sites for insulin (C), and exercising regularly (D) are all appropriate self-management strategies for individuals with diabetes mellitus.

2. When planning a scoliosis screening clinic, which age group should be included?

• A. early adolescent girls
• B. late adolescent boys
• C. 7-10 year old boys
• D. preschoolers of both genders

Correct answer: A

Rationale: The correct answer is early adolescent girls. Scoliosis is most commonly diagnosed during early adolescence, with girls being more affected than boys. Including early adolescent girls in the screening clinic aligns with the age group that is at higher risk for scoliosis. Late adolescent boys (choice B) are less likely to develop scoliosis compared to early adolescent girls. 7-10 year old boys (choice C) are typically younger than the age group where scoliosis is commonly diagnosed. Preschoolers of both genders (choice D) are too young for scoliosis screening as the condition usually manifests during adolescence.

3. When caring for a client with a chest tube, which intervention is most important to include in the plan of care?

• A. Maintain continuous suction on the chest tube.
• B. Clamp the chest tube during client movement.
• C. Ensure that the chest tube is clamped for at least 8 hours each day.
• D. Keep the collection chamber below the level of the chest.

Correct answer: D

Rationale: Keeping the collection chamber below the level of the chest is crucial in caring for a client with a chest tube. This positioning helps ensure proper drainage of fluids and prevents complications such as backflow of drainage into the chest cavity. Option A is incorrect as continuous suction can lead to excessive drainage and tissue damage. Option B is incorrect as clamping the chest tube during client movement can cause a buildup of pressure and compromise proper drainage. Option C is incorrect because clamping the chest tube for extended periods can impede the drainage process, leading to potential complications.

4. A primipara with a breech presentation is in the transition phase of labor. The nurse visualizes the perineum and sees the umbilical cord extruding from the introitus. In which position should the nurse place the client?

• A. Supine with the foot of the bed raised.
• B. On the left side with legs elevated.
• C. On the right side with legs elevated.
• D. Prone with head elevated.

Correct answer: A

Rationale: In the scenario of a primipara with a breech presentation and a prolapsed umbilical cord, the nurse should place the client in the supine position with the foot of the bed raised (Trendelenburg position). This position helps alleviate gravitational pressure by the fetus on the cord, preventing compression and reducing the risk of cord prolapse complications. Placing the client on the left or right side with legs elevated or in a prone position with the head elevated would not be appropriate in this situation, as they do not effectively relieve the pressure on the umbilical cord.

5. When assessing the health of a community, what is the most important information for the nurse to obtain?

• A. life expectancy of community members
• B. mortality rates in the community
• C. description of health problems by community leaders
• D. expressed needs of community members

Correct answer: D

Rationale: The most important information for a nurse to obtain when assessing the health of a community is the expressed needs of community members. This information helps in tailoring health interventions to address specific concerns directly expressed by the community. Options A and B focus on statistical data rather than individual needs. Option C, while valuable, may not always capture the full spectrum of health issues faced by the community as perceived by the residents themselves.

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