Nursing Elites

1. The nurse is teaching a client with gastroesophageal reflux disease (GERD) about dietary modifications. Which food should the client avoid?

• A. Applesauce
• B. White rice
• C. Coffee
• D. Bananas

Correct answer: C

Rationale: The correct answer is C: Coffee. Coffee should be avoided by clients with GERD as it can relax the lower esophageal sphincter, leading to an increase in GERD symptoms. Choices A, B, and D are not directly associated with worsening GERD symptoms and can be included in moderation in the diet of a client with GERD.

2. During the initial assessment of an older male client with obesity and diabetes who develops intermittent claudication, which additional information obtained by the nurse is most significant?

• A. Smokes 1.5 packs of cigarettes daily.
• B. Exercises regularly.
• C. Has a high-fat diet.
• D. Consumes alcohol daily.

Correct answer: A

Rationale: The correct answer is A: 'Smokes 1.5 packs of cigarettes daily.' Smoking is a significant risk factor for peripheral arterial disease, a condition that can lead to intermittent claudication. The nicotine and other chemicals in cigarettes can damage blood vessels, leading to reduced blood flow and increased risk of developing circulation problems. Choices B, C, and D are less significant in the context of intermittent claudication. Regular exercise, a high-fat diet, and daily alcohol consumption may have health implications, but they are not as directly linked to the development of intermittent claudication in the presence of obesity, diabetes, and smoking.

3. The nurse explains to the parents of a child with developmental hip dysplasia that the application of a Pavlik harness is necessary. In what position will the harness hold the child's femurs?

• A. Abduction
• B. Adduction
• C. Flexion
• D. Extension

Correct answer: A

Rationale: The correct answer is A: Abduction. The use of the Pavlik harness is to maintain the hips in abduction for 4 to 6 months to treat developmental hip dysplasia. This position helps in stabilizing the hip joint and promoting proper growth and development. Choices B, C, and D are incorrect because the Pavlik harness specifically aims to hold the child's femurs in abduction, not adduction, flexion, or extension.

4. The healthcare provider is assessing a client with a chest tube. Which finding indicates that the chest tube is functioning properly?

• A. Continuous bubbling in the water seal chamber
• B. Tidaling in the water seal chamber
• C. Absence of drainage in the collection chamber
• D. Fluid level in the suction control chamber is below the prescribed level

Correct answer: B

Rationale: Tidaling in the water seal chamber indicates proper chest tube function. Tidaling refers to the rise and fall of fluid in the water seal with inhalation and exhalation, demonstrating the patency of the system. Continuous bubbling (Choice A) in the water seal chamber indicates an air leak. Absence of drainage in the collection chamber (Choice C) is not a desired finding as it suggests no drainage is occurring. A fluid level below the prescribed level in the suction control chamber (Choice D) may indicate inadequate suction.

5. A client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 52, PaCO2 59, HCO3 33. Which statement describes the most likely cause of the simultaneous increase in both PaO2 and PaCO2?

• A. The client is hyperventilating due to anxiety.
• B. The hypoxic drive was reduced by the oxygen therapy.
• C. The client is experiencing respiratory alkalosis.
• D. The client is experiencing metabolic acidosis.

Correct answer: B

Rationale: Oxygen therapy can reduce the hypoxic drive in COPD patients, leading to increased PaCO2 levels while improving oxygenation (PaO2). In this case, the increase in PaO2 and PaCO2 is due to the reduction of the hypoxic drive by the supplemental oxygen. Choice A is incorrect because hyperventilation would lead to decreased PaCO2. Choice C is incorrect as the ABG values do not indicate respiratory alkalosis. Choice D is incorrect as the ABG values do not support metabolic acidosis.

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