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1. A client with Crohn's disease is receiving parenteral nutrition. Which of the following interventions should the nurse not include in the care of this client?
- A. Remove the parenteral nutrition solution from the refrigerator 2 hours before infusion.
- B. Remove unused parenteral nutrition after 12 hours of use.
- C. Monitor daily laboratory values and report abnormalities as needed.
- D. Monitor the flow rate of the parenteral nutrition carefully and adjust it if necessary.
Correct answer: B
Rationale: In caring for a client receiving parenteral nutrition, it is important to follow proper guidelines to ensure safety and effectiveness. Unused parenteral nutrition should be removed after 24 hours, not 12 hours, to prevent contamination and reduce the risk of infection. Option A is correct as it ensures the solution is at room temperature before infusion. Option C is essential for monitoring the client's response to parenteral nutrition. Option D is important to maintain the correct flow rate and adjust it as needed. Therefore, option B is the incorrect choice among the options provided.
2. The working phase in a therapy group is usually characterized by which of the following?
- A. Caution
- B. Cohesiveness
- C. Confusion
- D. Competition
Correct answer: D
Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.
3. The nurse is planning education about appropriate protein food choices for a client who has recently been prescribed a renal diet. Which protein food items should the nurse include in the education?
- A. Yogurt, seeds, and lentils
- B. Beef, bacon, and nuts
- C. Peanut butter, beans, and peas
- D. Poultry, eggs, and fish
Correct answer: D
Rationale: The correct answer is D: Poultry, eggs, and fish. These protein sources are high-quality proteins suitable for a renal diet as they provide essential amino acids without excessive amounts of potassium or phosphorus. Choice A, yogurt, seeds, and lentils, may be high in potassium and phosphorus, which could be restricted in a renal diet. Choice B, beef, bacon, and nuts, are also high in phosphorus and may not be ideal for a renal diet. Choice C, peanut butter, beans, and peas, are high in potassium and phosphorus, making them less suitable for a renal diet.
4. The mechanism behind most CKD in patients without diabetes is mediated by:
- A. enzyme systems
- B. immune systems
- C. catabolic systems
- D. hormonal systems
Correct answer: B
Rationale: In non-diabetic patients, CKD is often mediated by immune system responses. Chronic inflammation triggered by immune system dysfunction can contribute to progressive kidney damage. Therefore, the correct answer is 'immune systems.' Choices A, C, and D are incorrect because CKD in non-diabetic patients is primarily associated with immune system abnormalities rather than enzyme, catabolic, or hormonal systems.
5. Mang David, A 27 year old psychiatric client was admitted with a diagnosis of schizophrenia. During the morning assessment, Mang David shouted “Did you know that I am the top salesman in the world? Different companies want me!†As a nurse, you know that this is an example of:
- A. Hallucination
- B. Delusion
- C. Confabulation
- D. Flight of Ideas
Correct answer: B
Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.
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