Nursing Elites

1. A nurse is caring for a client who is receiving a continuous enteral tube feeding and reports cramping and abdominal distention. Which of the following actions should the nurse take?

• A. Check for gastric residual.
• B. Apply low intermittent suction.
• C. Increase the rate of the feeding.
• D. Request a higher-fat formula.

Correct answer: A

Rationale: Checking for gastric residual can help identify the cause of cramping and abdominal distention during enteral feedings.

2. A home health nurse is conducting an initial visit with an older adult client. The client lives alone and has difficulty preparing his own meals. Which of the following actions should the nurse take first?

• A. Discuss nutritional requirements with the client.
• B. Refer the client to a senior citizen center.
• C. Arrange for a home-delivered meal program.
• D. Perform a nutrition screening.

Correct answer: D

Rationale: Performing a nutrition screening first allows the nurse to assess the client's nutritional status and identify specific needs.

3. A nurse is initiating continuous enteral feedings for a client who has a new gastrostomy tube. Which of the following actions should the nurse take?

• A. Measure the client’s gastric residual every 12 hr.
• B. Obtain the client’s electrolyte levels every 4 hr.
• C. Keep the client’s head elevated at 15* during feedings.
• D. Flush the client’s tube with 30 mL of water every 4 hr.

Correct answer: D

Rationale: Flushing the client's tube with 30 mL of water every 4 hours helps maintain tube patency and prevent blockages.

4. A nurse is preparing to teach a group of clients about vitamins and minerals. The nurse should include in the teaching that which of the following minerals is necessary for the transmission of nerve impulses?

• A. Phosphorus
• B. Calcium
• C. Chloride
• D. Zinc

Correct answer: B

Rationale: Corrected Rationale: Calcium is essential for nerve transmission, muscle contraction, and blood clotting. It is a crucial mineral that plays a vital role in the proper functioning of the nervous system. Phosphorus is important for bone health and energy production but is not directly involved in nerve impulse transmission. Chloride is an electrolyte that helps maintain fluid balance but is not primarily responsible for nerve impulse transmission. Zinc is essential for immune function, wound healing, and DNA synthesis but is not directly related to nerve impulse transmission.

5. A nurse is caring for a client with a major burn injury and is receiving TPN. Which of the following lab tests is the priority for the nurse to use to confirm the client is receiving adequate nutrition?

• A. Iron
• B. Magnesium
• C. Folic acid
• D. Prealbumin

Correct answer: D

Rationale: Prealbumin is a sensitive indicator of protein status and nutrition, making it a priority for assessing nutritional adequacy in clients receiving TPN.

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