Nursing Elites

1. Which of the following foods should be avoided by clients who are prone to developing heartburn as a result of gastroesophageal reflux disease (GERD)?

• A. lettuce
• B. eggs
• C. chocolate
• D. butterscotch

Correct answer: C

Rationale: The correct answer is chocolate. Ingestion of chocolate can reduce lower esophageal sphincter (LES) pressure, leading to reflux and clinical symptoms of GERD. Lettuce and eggs do not significantly affect LES pressure, making them less likely to trigger GERD symptoms. Butterscotch, like lettuce and eggs, does not have a notable effect on LES pressure, so it is not as likely to worsen GERD symptoms as chocolate. Therefore, chocolate is the food to be avoided by clients prone to heartburn due to GERD.

2. A client with a closed chest tube drainage system accidentally disconnects the chest tube while being turned by the nurse. What should the nurse do first?

• A. Submerge the end of the chest tube in a bottle of sterile water
• B. Clamp the chest tube with a Kelly clamp
• C. Call the health care provider
• D. Instruct the client to inhale and hold his breath

Correct answer: A

Rationale: When a chest tube becomes disconnected, the priority action is to immediately reattach it to the drainage system or submerge the end in a bottle of sterile water or saline solution to reestablish a water seal. This helps prevent air from entering the pleural space and causing complications. Calling the health care provider is important but not the first action in this emergency. Instructing the client to inhale and hold his breath should be avoided as it can introduce atmospheric air into the pleural space, leading to potential issues. Clamping the chest tube is generally contraindicated, especially in cases of residual air leak or pneumothorax, as it may result in a tension pneumothorax by preventing air from escaping.

3. Which of the following NSAIDs is most commonly used for a brief period for acute pain?

• A. Advil
• B. Aleve
• C. Toradol
• D. Bextra

Correct answer: C

Rationale: Toradol is the correct answer because it is an NSAID known for its effectiveness in managing acute pain for short durations. It can be administered via intramuscular (IM), intravenous (IV), or oral (PO) routes. Advil (choice A) and Aleve (choice B) are commonly used for mild to moderate pain but may not be as effective for acute pain requiring immediate relief. Bextra (choice D) was withdrawn from the market due to safety concerns, making it an inappropriate choice for acute pain management.

4. Which of the following is responsible for laws mandating the reporting of certain infections and diseases?

• A. Centers for Disease Control and Prevention (CDC)
• B. individual state laws
• C. National Institutes of Health (NIH)
• D. Health and Human Services (HHS)

Correct answer: B

Rationale: Individual state laws mandate the reporting of infectious diseases. The list of reportable diseases varies from state to state and is overseen by state health departments. While the CDC plays a significant role in disease surveillance, reporting infectious diseases is primarily governed by individual state laws. The CDC's role is to provide support, guidance, and expertise to state health departments. The National Institutes of Health (NIH) primarily focus on biomedical and health-related research, not on mandating disease reporting. Health and Human Services (HHS) is a federal department that oversees various agencies, but the responsibility for mandating disease reporting lies with individual states.

5. The LPN is receiving the report on a comatose client at the start of the shift at 1500. What statement should be of most concern?

• A. The client was repositioned on his right side at 1100.
• B. The client was bathed, and the skin was assessed head-to-toe at 0900 with no abnormal findings.
• C. The client's PEG tube was changed 6 months ago.
• D. The client's indwelling urinary catheter was last changed 5 days ago.

Correct answer: D

Rationale: When caring for a comatose client, it is crucial to monitor and maintain the integrity of the indwelling urinary catheter to prevent urinary tract infections and other complications. Changing the urinary catheter less frequently than recommended increases the risk of infection. In this scenario, the most concerning issue is the prolonged duration since the last change of the indwelling urinary catheter, which poses an immediate risk to the client's health. While repositioning every 2 hours is essential to prevent skin breakdown, the most critical aspect in this case is the catheter care. Bathing and skin assessment are important for overall hygiene and skin integrity but are not as urgent as catheter care. The timing of the PEG tube change, while relevant for care planning, is not as immediate a concern as the indwelling urinary catheter status.

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