Nursing Elites

1. Which of the following interventions is most appropriate for a client with hyperemesis gravidarum?

• A. Encourage high-calorie meals
• B. Administer intravenous fluids
• C. Provide frequent small meals
• D. Limit fluid intake

Correct answer: B

Rationale: The correct answer is B: Administer intravenous fluids. Hyperemesis gravidarum is severe, persistent nausea and vomiting during pregnancy that can lead to dehydration and electrolyte imbalances. The priority intervention is to administer intravenous fluids to maintain hydration. Encouraging high-calorie meals (Choice A) may exacerbate symptoms due to increased gastric stimulation. Providing frequent small meals (Choice C) may not be effective in severe cases where continuous vomiting occurs. Limiting fluid intake (Choice D) is contraindicated in hyperemesis gravidarum as dehydration is a significant concern.

2. A client with a new prescription for an albuterol metered-dose inhaler is being taught by a nurse. Which of the following instructions should the nurse include in the teaching?

• A. Inhale quickly when using the inhaler.
• B. Hold your breath for 10 seconds after inhaling the medication.
• C. Take a second puff of the inhaler immediately after the first.
• D. Exhale fully after using the inhaler.

Correct answer: B

Rationale: The correct instruction is to hold your breath for 10 seconds after inhaling the medication. This allows the medication to settle in the lungs and maximize its effectiveness. Choice A is incorrect as inhaling quickly may lead to improper medication delivery. Choice C is wrong because taking a second puff immediately after the first without waiting for the prescribed interval may cause an overdose. Choice D is also incorrect as exhaling fully after using the inhaler may result in the medication being exhaled rather than absorbed by the lungs.

3. A nurse is preparing to administer an enteral tube feeding through an NG tube at 250 mL over 4 hr. The nurse should set the pump to deliver how many mL/hr?

• A. 60 mL/hr
• B. 62 mL/hr
• C. 63 mL/hr
• D. 65 mL/hr

Correct answer: C

Rationale: Calculation: 250 mL / 4 hours = 62.5 mL/hr, which should be rounded up to 63 mL/hr. This ensures the correct rate is set for continuous feeding. Choice A (60 mL/hr) is incorrect as it does not reflect the accurate calculation. Choice B (62 mL/hr) is close but does not round up to the nearest whole number as required. Choice D (65 mL/hr) is higher than the correct calculation and would deliver the feeding solution at a faster rate than prescribed.

4. A nurse is reviewing dietary assessment findings for a client who is Jewish and observes kosher dietary practices. Which of the following behaviors should the nurse expect to find?

• A. Leavened bread may be eaten during Passover
• B. Shellfish is commonly consumed in the diet
• C. Meat and dairy products are eaten separately
• D. Fasting from meat occurs during Hanukkah

Correct answer: C

Rationale: The correct answer is C. According to kosher dietary laws, meat and dairy products cannot be consumed together. This practice stems from the prohibition in Jewish law against cooking a young animal in its mother's milk. Therefore, the nurse should expect to find that meat and dairy products are eaten separately. Choices A, B, and D are incorrect. Leavened bread is not eaten during Passover (Choice A), shellfish is not consumed in the kosher diet (Choice B), and fasting from meat does not occur during Hanukkah (Choice D).

5. A client receiving opiates for pain management was initially sedated but is no longer sedated after three days. What action should the nurse take?

• A. Initiate additional non-pharmacological pain management techniques.
• B. Notify the provider that a dosage adjustment is needed.
• C. No action is needed at this time.
• D. Contact the provider to request an alternate method of pain management.

Correct answer: C

Rationale: The correct answer is C: No action is needed at this time. Sedation from opiates commonly decreases as the body adjusts to the medication. It is a positive sign that the sedation has resolved, indicating the client is tolerating the current dosage well. Initiating additional non-pharmacological pain management techniques (Choice A) is unnecessary since the current pain management regimen is effective. Notifying the provider for a dosage adjustment (Choice B) is premature and not indicated when the sedation has resolved. Contacting the provider to request an alternate method of pain management (Choice D) is excessive and not warranted in this situation where the client is no longer sedated and the current pain management plan is effective.

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