Nursing Elites

1. When conducting discharge teaching for a client diagnosed with diverticulosis, which diet instruction should the nurse include?

• A. Eat a high-fiber diet and increase fluid intake.
• B. Have small frequent meals and sit up for at least two hours after meals.
• C. Eat a bland diet and avoid spicy foods.
• D. Eat a soft diet with increased intake of milk and milk products.

Correct answer: A

Rationale: A high-fiber diet with increased fluid intake is the most appropriate diet instruction for a client diagnosed with diverticulosis. High-fiber foods help prevent constipation and promote bowel regularity, reducing the risk of complications such as diverticulitis. Adequate fluid intake is crucial to soften stool and aid in digestion. Choice B, having small frequent meals and sitting up after meals, may be beneficial for some gastrointestinal conditions but is not specific to diverticulosis. Choice C, eating a bland diet and avoiding spicy foods, is not necessary for diverticulosis management. Choice D, consuming a soft diet with increased milk and milk products, may worsen symptoms in diverticulosis due to the potential for increased gas production and bloating.

2. A client with a history of type 1 diabetes Mellitus (DM) and asthma is readmitted to the unit for the third time in two months with a current fasting blood sugar (FBS) of 325mg/dl (18mmol/L SI). The client describes to the nurse not understanding why the blood glucose level continues to be out of control. Which interventions should the nurse implement?

• A. Have the client describe a typical day at work, home, and social activities
• B. Determine if the client is using a new insulin needle for each administration
• C. Evaluate the client's asthma medications that can elevate blood glucose
• D. Have the client demonstrate the technique used to monitor blood glucose levels

Correct answer: A

Rationale: The correct answer is to have the client describe a typical day at work, home, and social activities. By understanding the client's daily routine, the nurse can gain valuable insights into lifestyle factors that may be impacting blood glucose control. This information is essential for identifying potential triggers or patterns contributing to the elevated blood sugar levels. Option B, determining if the client is using a new insulin needle for each administration, focuses more on the technical aspect of insulin delivery and is not directly related to daily activities affecting blood glucose levels. Option C, evaluating the client's asthma medications that can elevate blood glucose, could be relevant but is not as directly linked to the client's lifestyle choices as option A. Option D, having the client demonstrate the technique for monitoring blood glucose levels, is important for assessing their skills but does not provide information on daily activities that may be influencing blood sugar levels.

3. A client without a history of respiratory disease has a pulse oximeter in place after surgery. The nurse monitors the pulse oximeter readings to ensure that oxygen saturation remains above:

• A. 85%
• B. 89%
• C. 95%
• D. 100%

Correct answer: C

Rationale: Pulse oximetry is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin (SaO2). In the absence of underlying respiratory disease, the expected oxygen saturation level is at least 95%. Oxygen saturation levels below 95% may indicate hypoxemia, which can compromise tissue perfusion and oxygen delivery to vital organs. Therefore, maintaining oxygen saturation above 95% is crucial to ensure adequate oxygenation post-surgery. Choices A, B, and D are incorrect as they represent oxygen saturation levels that are below the expected value for a client without a history of respiratory disease, which should be at least 95%.

4. To assess the quality of an adult client's pain, what approach should the nurse use?

• A. Observe body language and movement.
• B. Ask the client to describe the pain.
• C. Identify effective pain relief measures.
• D. Provide a numeric pain scale.

Correct answer: B

Rationale: The correct answer is to ask the client to describe the pain. This approach allows the nurse to gather subjective information directly from the client, such as the quality, intensity, location, and factors that aggravate or alleviate the pain. Observing body language and movement (Choice A) can provide additional cues but may not fully capture the client's pain experience. Identifying effective pain relief measures (Choice C) and providing a numeric pain scale (Choice D) are important aspects of pain management but do not directly assess the quality of the client's pain.

5. What discharge instruction is most important for a client after a kidney transplant?

• A. Weigh weekly.
• B. Report symptoms of secondary Candidiasis.
• C. Use daily reminders to take immunosuppressants.
• D. Stop cigarette smoking.

Correct answer: C

Rationale: After a kidney transplant, it is crucial for the client to adhere to the prescribed immunosuppressive therapy to prevent organ rejection. The client must take medications like corticosteroids and azathioprine (Imuran) regularly for the rest of their life. Using daily reminders is essential to ensure compliance with the medication regimen, as missing doses can increase the risk of organ rejection. Weighing weekly, reporting symptoms of secondary Candidiasis, and stopping cigarette smoking are important aspects of post-transplant care but may not be as critical as ensuring proper intake of immunosuppressants to prevent rejection.

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