Nursing Elites

1. A nurse is caring for a client post-op with a chest tube. What should the nurse check for regularly?

• A. Ensure the chest tube is periodically clamped
• B. Check for air leaks in the tubing
• C. Keep the client in a prone position for chest drainage
• D. Administer diuretics to prevent fluid buildup

Correct answer: B

Rationale: The correct answer is to check for air leaks in the tubing. Air leaks can compromise the function of the chest tube, leading to inadequate drainage and potentially causing complications for the client. Clamping the chest tube periodically is incorrect as it could lead to a buildup of fluid or air in the pleural space. Keeping the client in a prone position is not necessary for chest drainage, as the positioning may vary depending on the specific situation. Administering diuretics may not be directly related to monitoring the chest tube for proper function and is not a routine intervention for chest tube management post-op.

2. What is the priority nursing action for a client with dehydration?

• A. Administer oral fluids
• B. Monitor electrolyte levels
• C. Administer antiemetics as needed
• D. Encourage bed rest

Correct answer: B

Rationale: The priority nursing action for a client with dehydration is to monitor electrolyte levels. Dehydration can cause imbalances in electrolytes such as sodium and potassium, affecting essential bodily functions. Monitoring electrolyte levels is crucial to promptly identify and correct any imbalances. While administering oral fluids (Choice A) is vital in treating dehydration, monitoring electrolyte levels takes precedence as it directly addresses the underlying imbalance. Administering antiemetics (Choice C) may be necessary for nausea and vomiting but is not the priority over electrolyte monitoring. Encouraging bed rest (Choice D) can conserve energy but is not as critical as monitoring electrolyte levels to prevent complications related to electrolyte imbalances.

3. Which of the following is a key consideration when caring for a client with heart failure on fluid restriction?

• A. Encourage the client to drink more fluids to stay hydrated
• B. Weigh the client daily to monitor fluid status
• C. Limit the client's intake of fruits and vegetables
• D. Monitor the client's fluid intake only during meals

Correct answer: B

Rationale: When caring for a client with heart failure on fluid restriction, weighing the client daily is crucial to monitor fluid balance accurately. This helps healthcare providers assess if the client is retaining excess fluids, which can worsen heart failure. Encouraging the client to drink more fluids (choice A) contradicts the goal of fluid restriction. Limiting intake of fruits and vegetables (choice C) is not a specific guideline for managing fluid restriction in heart failure. Monitoring fluid intake only during meals (choice D) is insufficient as fluid balance needs to be monitored consistently throughout the day.

4. How should a healthcare professional manage a patient with diarrhea?

• A. Provide oral fluids and monitor stool consistency
• B. Administer antidiarrheal medications and monitor hydration
• C. Monitor for electrolyte imbalances and provide antibiotics
• D. Provide a low-fiber diet and monitor weight

Correct answer: A

Rationale: For a patient with diarrhea, the priority is to manage dehydration by providing oral fluids and monitoring stool consistency. Option B suggesting administering antidiarrheal medications is not recommended as it may prolong the infection by preventing the body from expelling the infectious agent. Option C is incorrect because antibiotics are not routinely indicated for diarrhea unless there is a specific bacterial infection. Option D is not the most appropriate initial intervention for managing diarrhea since a low-fiber diet may not provide adequate nutrition for the patient or help resolve the underlying cause of diarrhea.

5. A client with hypertension is receiving lifestyle education from a nurse. What should be emphasized?

• A. Encourage a low-sodium diet
• B. Advise the client to avoid caffeinated drinks
• C. Recommend increasing high-protein foods
• D. Advise the client to reduce fat intake

Correct answer: B

Rationale: The correct answer is to advise the client to avoid caffeinated drinks. Caffeine can temporarily increase blood pressure, so avoiding caffeinated drinks can help manage hypertension. Encouraging a low-sodium diet (Choice A) is essential for hypertension management as excess sodium can raise blood pressure. Increasing high-protein foods (Choice C) is not a primary focus in managing hypertension. While reducing fat intake (Choice D) can be beneficial for overall health, it is not the priority in lifestyle modifications for hypertension.

Similar Questions