Nursing Elites

1. The nurse is providing teaching to a client with gastroesophageal reflux disease (GERD). Which instruction should the nurse include?

• A. Eat large meals to decrease acid production
• B. Avoid lying down immediately after eating
• C. Limit fluid intake with meals
• D. Drink carbonated beverages to aid digestion

Correct answer: B

Rationale: The correct instruction for a client with GERD is to avoid lying down immediately after eating. This helps prevent stomach acid from flowing back into the esophagus, which can worsen symptoms. Eating large meals can actually increase acid production and exacerbate GERD. Limiting fluid intake with meals may be beneficial for some individuals, but it is not a key instruction for managing GERD. Drinking carbonated beverages can trigger reflux symptoms and should be avoided by individuals with GERD.

2. A client with Crohn's disease reports diarrhea. What intervention should the nurse implement?

• A. Instruct the client to drink clear fluids and avoid solid foods.
• B. Administer antidiarrheal medication as prescribed.
• C. Encourage a high-fiber diet and regular physical activity.
• D. Restrict fluid intake and monitor electrolytes.

Correct answer: C

Rationale: The correct intervention for a client with Crohn's disease reporting diarrhea is to encourage a high-fiber diet and regular physical activity. A high-fiber diet helps manage diarrhea in Crohn's disease by adding bulk to the stool and promoting more regular bowel movements. Instructing the client to drink clear fluids and avoid solid foods (Choice A) may not be appropriate as it can further exacerbate diarrhea. Administering antidiarrheal medication (Choice B) without addressing the underlying cause may not be the best initial approach. Encouraging a high-fiber diet and physical activity (Choice C) is beneficial for managing symptoms. Restricting fluid intake and monitoring electrolytes (Choice D) is not recommended as it can lead to dehydration, which is a concern in clients with diarrhea.

3. The nurse is providing care for a client with a percutaneous endoscopic gastrostomy (PEG) tube. Which intervention should the nurse implement to prevent complications associated with the tube?

• A. Elevate the head of the bed to 15 degrees during feedings
• B. Aspirate gastric contents before administering medications
• C. Clamp the tube between feedings
• D. Flush the tube with water before and after feedings

Correct answer: D

Rationale: Flushing the PEG tube with water before and after feedings helps prevent clogging and maintains tube patency. Proper flushing is essential for avoiding complications related to tube blockages. Elevating the head of the bed is important for preventing aspiration during and after feedings, not specifically related to PEG tube complications. Aspirating gastric contents before administering medications is not routinely recommended for PEG tube care. Clamping the tube between feedings can lead to tube occlusion and is not a standard practice in PEG tube care.

4. A male client reports numbness and tingling in his fingers and around his mouth. What laboratory value should the nurse review?

• A. Capillary glucose.
• B. Serum calcium.
• C. Urine specific gravity.
• D. White blood cell count.

Correct answer: B

Rationale: The correct answer is B, Serum calcium. Numbness and tingling in the fingers and around the mouth are indicative of hypocalcemia, a condition characterized by low calcium levels in the blood. Reviewing the client's serum calcium levels is crucial in this situation to assess for hypocalcemia. Choice A, Capillary glucose, is incorrect because symptoms described are not typically associated with glucose abnormalities. Choice C, Urine specific gravity, and Choice D, White blood cell count, are unrelated to the symptoms presented and are not indicative of the client's condition.

5. Which intervention should be prioritized by the nurse when assessing tissue perfusion post-above knee amputation (AKA)?

• A. Evaluate the closest proximal pulse.
• B. Observe color and amount of wound drainage.
• C. Observe for swelling around the stump.
• D. Assess the skin elasticity of the stump.

Correct answer: A

Rationale: The correct answer is to evaluate the closest proximal pulse when assessing tissue perfusion post-above knee amputation (AKA). Checking the closest proximal pulse provides the best indication of tissue perfusion in the extremities after an AKA procedure. Observing the color and amount of wound drainage (Choice B) is important for wound care but does not directly assess tissue perfusion. Observing for swelling around the stump (Choice C) may indicate inflammation or fluid accumulation but is not the most direct way to assess tissue perfusion. Assessing the skin elasticity of the stump (Choice D) is more related to skin integrity and wound healing rather than tissue perfusion.

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