Nursing Elites

1. In an emergency department, a provider is assessing a client with an acute head injury following a motor-vehicle crash. Which of the following findings should be prioritized?

• A. A Glasgow Coma Scale score of 13
• B. Clear fluid leaking from the nose
• C. Nausea and vomiting
• D. Anisocoria

Correct answer: B

Rationale: The priority finding is the clear fluid leaking from the nose, which could indicate a cerebrospinal fluid leak and potential brain injury. This requires immediate attention to assess for possible cerebrospinal fluid leak, which is a serious complication of head trauma and needs prompt intervention to prevent further complications. While a Glasgow Coma Scale score of 13 may indicate a mild alteration in consciousness, it is not as urgent as assessing for a cerebrospinal fluid leak. Nausea and vomiting are common symptoms after head injuries but do not take precedence over assessing for a potential cerebrospinal fluid leak. Anisocoria (unequal pupils) is also important to note but is not as urgent as identifying a possible cerebrospinal fluid leak in this scenario.

2. A nurse is caring for a client who has a new prescription for a low-cholesterol diet. Which of the following foods should the nurse recommend?

• A. Eggs
• B. Cheese
• C. Chicken breast
• D. Butter

Correct answer: C

Rationale: Chicken breast is a suitable recommendation for a low-cholesterol diet as it is low in cholesterol. Eggs and cheese are high in cholesterol and not suitable for a low-cholesterol diet. Butter is also high in cholesterol and should be avoided in a low-cholesterol diet.

3. A client with a new diagnosis of hyperlipidemia is receiving teaching from a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will decrease my intake of fiber.
• B. I will increase my intake of red meat.
• C. I will decrease my intake of saturated fats.
• D. I will increase my intake of salt.

Correct answer: C

Rationale: The correct answer is C. Decreasing saturated fats is essential in managing hyperlipidemia. Saturated fats can raise LDL cholesterol levels, contributing to the condition. By reducing intake of saturated fats, the client can help lower their cholesterol levels and improve their overall lipid profile. Choices A, B, and D are incorrect. Decreasing fiber intake (Choice A) is not recommended as fiber can help lower cholesterol levels. Increasing red meat intake (Choice B) is not advisable as red meat is often high in saturated fats. Increasing salt intake (Choice D) is unrelated to managing hyperlipidemia and can even be detrimental due to its association with high blood pressure.

4. When assessing a client with chronic pain, which of the following is the most reliable indicator of the client's pain?

• A. The client's vital signs.
• B. The client's self-report of pain.
• C. The client's body language.
• D. The client's medical history.

Correct answer: B

Rationale: The client's self-report of pain is the most reliable indicator of pain. Pain is a subjective experience, and the client's self-report provides direct insight into their perception of pain intensity, quality, and impact on daily life. Vital signs, body language, and medical history can offer additional information but may not accurately reflect the client's actual pain experience. Therefore, relying on the client's self-report ensures a more accurate assessment of their pain and helps in tailoring appropriate interventions and treatment plans.

5. A client has a new diagnosis of hyperthyroidism and is being taught about dietary management. Which of the following statements should the nurse include in the teaching?

• A. You should increase your intake of iodine-rich foods.
• B. You should avoid foods that contain iodine.
• C. You should increase your intake of dairy products.
• D. You should avoid foods that contain gluten.

Correct answer: B

Rationale: The correct answer is B. In hyperthyroidism, it is advisable to avoid foods that contain iodine to help manage the condition and prevent complications. Excessive iodine intake can exacerbate hyperthyroidism symptoms by stimulating the thyroid gland. Therefore, the nurse should include information about avoiding iodine-rich foods in the client's dietary management teaching. Choices A, C, and D are incorrect because increasing intake of iodine-rich foods can worsen hyperthyroidism symptoms, increasing dairy products is not specific to managing hyperthyroidism, and avoiding gluten is more relevant for conditions like celiac disease, not hyperthyroidism.

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