Nursing Elites

1. A nurse is planning care for a client who had gastric bypass surgery 1 week ago and has signs of early dumping syndrome. Which of the following findings should the nurse expect?

• A. Facial flushing
• B. Syncope
• C. Diaphoresis
• D. Bradycardia

Correct answer: A

Rationale: Facial flushing is a common symptom of early dumping syndrome, which occurs when food moves too quickly into the small intestine. This rapid movement triggers the release of vasoactive peptides causing vasodilation, leading to facial flushing. Syncope (choice B) is not a typical finding in early dumping syndrome. Diaphoresis (choice C) and bradycardia (choice D) are also not characteristic symptoms of early dumping syndrome.

2. A nurse is caring for a client who is at risk for pressure ulcers. Which of the following interventions should the nurse implement?

• A. Turn the client every 2 hours
• B. Use a donut-shaped cushion when sitting
• C. Elevate the head of the bed to 45 degrees
• D. Massage reddened areas to increase circulation

Correct answer: A

Rationale: The correct intervention for preventing pressure ulcers in a client at risk is to turn the client every 2 hours. This helps relieve pressure on bony prominences, improving circulation and preventing tissue damage. Using a donut-shaped cushion can actually increase pressure on the skin and worsen the risk of pressure ulcers. Elevating the head of the bed to 45 degrees is beneficial for preventing aspiration in some cases but does not directly address pressure ulcer prevention. Massaging reddened areas can further damage the skin and increase the risk of pressure ulcer development by causing friction and shearing forces.

3. A nurse is planning care for a client who practices Orthodox Judaism and is observing the Passover holiday. Which of the following actions should the nurse include in the plan of care?

• A. Provide chicken with cream sauce.
• B. Avoid serving fish with fins and scales.
• C. Provide unleavened bread.
• D. Avoid serving foods containing lamb.

Correct answer: C

Rationale: During the Passover holiday, individuals practicing Orthodox Judaism follow dietary restrictions that include avoiding leavened bread. Providing unleavened bread aligns with these restrictions and ensures the client's observance of the holiday. Choices A, B, and D are incorrect because serving chicken with cream sauce, avoiding fish with fins and scales, and avoiding foods containing lamb are not specific dietary requirements related to observing Passover in Orthodox Judaism.

4. A nurse overhears two assistive personnel (AP) discussing a client in an elevator. What action should the nurse take?

• A. Contact the client's family about the incident.
• B. Notify the client's provider about the incident.
• C. File a complaint with the facility's ethics committee.
• D. Report the incident to the AP's charge nurse.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to report the incident to the AP's charge nurse. This is important because discussing a client's information violates confidentiality policies. Contacting the client's family (Choice A) is not appropriate as it may breach confidentiality further. Notifying the client's provider (Choice B) is not the initial action to take in this situation, as addressing it within the facility should come first. Filing a complaint with the facility's ethics committee (Choice C) is not the immediate step and might not directly address the issue at hand.

5. A nurse is assessing a client who has gastroesophageal reflux disease (GERD). Which of the following findings should the nurse expect?

• A. Abdominal distention
• B. Burning sensation in the chest
• C. Constipation
• D. Frequent belching

Correct answer: B

Rationale: The correct answer is B: Burning sensation in the chest. A burning sensation in the chest is a classic symptom of gastroesophageal reflux disease (GERD). Abdominal distention (Choice A) is not typically associated with GERD; it is more commonly seen in conditions like bowel obstruction. Constipation (Choice C) is not a hallmark symptom of GERD, as it is more related to gastrointestinal motility issues. Frequent belching (Choice D) can occur with GERD, but it is not as specific or characteristic as the burning sensation in the chest.

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