Nursing Elites

1. Which of the following statements indicates the client understands the colostomy care instructions?

• A. I will change the colostomy bag once a week.
• B. I will avoid eating high-fiber foods.
• C. I will clean around the stoma with mild soap and water.
• D. I will apply lotion to the skin around the stoma.

Correct answer: C

Rationale: The correct answer is C. Cleaning around the stoma with mild soap and water is crucial for colostomy care as it helps prevent infection and skin irritation. Changing the colostomy bag frequency, dietary modifications, or applying lotion are not primary aspects of stoma care. Proper cleaning around the stoma helps maintain hygiene and prevents complications, making it a key component of caring for a colostomy.

2. A healthcare provider is preparing to administer an intramuscular injection to an adult client. Which of the following injection sites should the healthcare provider select?

• A. Deltoid muscle
• B. Dorsogluteal muscle
• C. Vastus lateralis muscle
• D. Rectus femoris muscle

Correct answer: A

Rationale: The deltoid muscle is a common site for intramuscular injections in adults due to its accessibility and muscle mass. It is located in the upper arm and provides a sufficient area for injection. The deltoid muscle is preferred for administering vaccines and other medications that require IM administration. Choice B, the dorsogluteal muscle, is not recommended for intramuscular injections due to the proximity of major nerves and blood vessels in that area, which can lead to nerve damage or injury. Choice C, the vastus lateralis muscle, is more commonly used for infants and young children, while choice D, the rectus femoris muscle, is not typically used for intramuscular injections in adults.

3. When teaching a client with a new diagnosis of hypertension about medication adherence, which statement should the nurse include?

• A. You can stop taking your medication once your blood pressure is normal.
• B. You should take your medication at the same time every day.
• C. You can double your dose if you miss a dose.
• D. You should take your medication with a high-fat meal.

Correct answer: B

Rationale: The correct answer is B: 'You should take your medication at the same time every day.' Taking medication consistently at the same time daily is crucial for maintaining steady blood levels and effectively managing hypertension. It helps ensure that the medication works optimally and provides the best control of blood pressure throughout the day. Choice A is incorrect because stopping medication once blood pressure is normal can lead to a relapse or worsening of hypertension. Choice C is incorrect as doubling the dose without healthcare provider guidance can be dangerous. Choice D is incorrect as taking medication with a high-fat meal can affect its absorption and efficacy.

4. When teaching a client with a new diagnosis of hepatitis about dietary management, which of the following statements should the nurse include?

• A. Increase your intake of high-protein foods.
• B. Decrease your intake of high-protein foods.
• C. Avoid foods that contain lactose.
• D. Increase your intake of dairy products.

Correct answer: B

Rationale: For a client with hepatitis, it is important to decrease the intake of high-protein foods. High-protein foods can be harder for the liver to process and may exacerbate symptoms or contribute to liver damage. Recommending a diet with moderate protein intake is beneficial for managing symptoms and promoting liver health. Choice A is incorrect as increasing high-protein foods can strain the liver. Choice C is not directly related to hepatitis unless there is an intolerance present. Choice D is also incorrect because increasing dairy products may not be suitable for all individuals with hepatitis, especially if there are underlying liver conditions that could be aggravated by certain dairy components.

5. A client with a new diagnosis of hypertension is being taught about lifestyle changes. Which of the following statements should the nurse include in the teaching?

• A. You should limit your alcohol intake to no more than one drink per day.
• B. You should increase your sodium intake to at least 2,300 mg per day.
• C. You should limit your physical activity to avoid increasing your blood pressure.
• D. You should avoid eating dairy products to help lower your blood pressure.

Correct answer: A

Rationale: The correct statement to include in teaching a client with hypertension is to limit alcohol intake to no more than one drink per day. Excessive alcohol consumption can raise blood pressure and lead to complications. Increasing sodium intake, limiting physical activity, and avoiding dairy products are not recommended for managing hypertension. Clients with hypertension should follow a heart-healthy diet low in sodium, engage in regular physical activity, and monitor their blood pressure regularly to control hypertension effectively.

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