Nursing Elites

1. A nurse is planning care for a client following gastric bypass surgery. The nurse should include which of the following dietary instructions when preparing the client for discharge?

• A. Start each meal with a protein source.
• B. Consume at least 25g of fiber daily.
• C. Check your blood glucose level before each meal.
• D. Limit your meals to three times per day.

Correct answer: A

Rationale: The correct answer is A: 'Start each meal with a protein source.' Protein is crucial for healing and maintaining muscle mass after gastric bypass surgery, making it essential to include in each meal. Choice B is incorrect because immediately after surgery, the focus is typically on a low-fiber diet to aid in healing. Choice C is unrelated to the nutritional needs following gastric bypass surgery. Choice D is also incorrect as patients recovering from gastric bypass surgery may require more frequent, smaller meals to meet their nutritional needs.

2. A client who is 38 weeks pregnant with herpes simplex virus is admitted to labor and delivery. What question should the nurse ask?

• A. Do you have any active lesions?
• B. Have your membranes ruptured?
• C. How far apart are your contractions?
• D. Are you positive for beta strep?

Correct answer: A

Rationale: The correct question the nurse should ask the client who is 38 weeks pregnant with herpes simplex virus is 'Do you have any active lesions?' This is crucial because active herpes lesions may necessitate a cesarean delivery to prevent neonatal infection. Choice B, 'Have your membranes ruptured?' is related to assessing for the rupture of membranes, not specific to the client's herpes infection. Choice C, 'How far apart are your contractions?' is related to monitoring labor progress. Choice D, 'Are you positive for beta strep?' is related to group B streptococcus screening, which is important but not the priority in this scenario.

3. A community health nurse is reviewing primary prevention for West Nile virus with a group of patients in a rural health clinic. What instructions should the nurse include?

• A. Eliminate areas of standing water.
• B. Wear a mask when outdoors.
• C. Ensure food is cooked thoroughly.
• D. Avoid contact with sick individuals.

Correct answer: A

Rationale: The correct answer is A: 'Eliminate areas of standing water.' Standing water provides breeding grounds for mosquitoes, which spread West Nile virus. By eliminating standing water, individuals can reduce the risk of mosquito breeding and the transmission of the virus. Choices B, C, and D are incorrect. Wearing a mask when outdoors, ensuring food is cooked thoroughly, and avoiding contact with sick individuals are not directly related to primary prevention strategies for West Nile virus.

4. A nurse is teaching a client with mild persistent asthma who has been prescribed montelukast. Which statement by the nurse is appropriate?

• A. This medication can be used during an acute asthma attack.
• B. This medication should be taken before exercise.
• C. You can take this medication for 10 days, then discontinue.
• D. This medication helps decrease swelling and mucus production.

Correct answer: D

Rationale: The correct answer is D: 'This medication helps decrease swelling and mucus production.' Montelukast is used for long-term asthma management as it helps reduce inflammation and mucus production in the airways. It is not appropriate for acute asthma attacks. Choice A is incorrect because montelukast is not a rescue medication for acute attacks. Choice B is incorrect because montelukast is not specifically taken before exercise. Choice C is incorrect because montelukast is usually taken regularly, not just for a short duration.

5. A nurse is planning to administer diltiazem via IV bolus to a client who has atrial fibrillation. Which of the following findings is a contraindication to the administration of diltiazem?

• A. Hypotension
• B. Tachycardia
• C. Decreased level of consciousness
• D. History of diuretic use

Correct answer: A

Rationale: The correct answer is A: Hypotension. Diltiazem, a calcium channel blocker, can cause hypotension. Administering diltiazem to a client with hypotension can further lower their blood pressure, leading to adverse effects like dizziness and syncope. Tachycardia (Choice B) is actually a common indication for diltiazem use, as it helps slow down the heart rate in conditions like atrial fibrillation. Decreased level of consciousness (Choice C) may require evaluation but is not a direct contraindication to diltiazem administration. History of diuretic use (Choice D) is not a contraindication to diltiazem, as the two medications can often be safely used together.

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