Nursing Elites

1. When planning care for a client with a pressure ulcer, which intervention should the nurse include in the plan?

• A. Massage the reddened area.
• B. Apply a donut-shaped cushion.
• C. Reposition the client every 3 hours.
• D. Use a transparent film dressing.

Correct answer: D

Rationale: The correct intervention for a client with a pressure ulcer is to use a transparent film dressing. This dressing provides a protective barrier against external contaminants while allowing for wound inspection, promoting healing. Massaging the reddened area can cause further damage to the skin and should be avoided. Donut-shaped cushions can increase pressure on the ulcer site rather than alleviate it. Repositioning the client every 2 hours is a preventive measure for pressure ulcers, but once an ulcer has developed, using a transparent film dressing is a more appropriate intervention to facilitate healing and protect the wound site.

2. A client with osteoporosis is being taught about dietary management. Which statement indicates an understanding of the teaching?

• A. I should increase my intake of foods high in vitamin D.
• B. I should decrease my intake of foods high in calcium.
• C. I should increase my intake of foods high in phosphorus.
• D. I should decrease my intake of foods high in potassium.

Correct answer: A

Rationale: The correct answer is A. Increasing intake of foods high in vitamin D is beneficial for improving calcium absorption and managing osteoporosis. Vitamin D helps the body absorb calcium, which is essential for bone health and can aid in managing osteoporosis effectively. Choice B is incorrect because reducing calcium intake would be counterproductive for a client with osteoporosis, as calcium is crucial for bone strength. Choice C is incorrect as phosphorus, while important for bone health, does not directly impact osteoporosis management as much as vitamin D and calcium. Choice D is incorrect as potassium is not directly linked to osteoporosis management, and reducing its intake is not typically part of dietary recommendations for osteoporosis.

3. When assessing a client with chronic pain, which of the following is the most reliable indicator of the client's pain?

• A. The client's vital signs.
• B. The client's self-report of pain.
• C. The client's body language.
• D. The client's medical history.

Correct answer: B

Rationale: The client's self-report of pain is the most reliable indicator of pain. Pain is a subjective experience, and the client's self-report provides direct insight into their perception of pain intensity, quality, and impact on daily life. Vital signs, body language, and medical history can offer additional information but may not accurately reflect the client's actual pain experience. Therefore, relying on the client's self-report ensures a more accurate assessment of their pain and helps in tailoring appropriate interventions and treatment plans.

4. A nurse is caring for a client who has a new prescription for a low-cholesterol diet. Which of the following foods should the nurse recommend?

• A. Eggs
• B. Cheese
• C. Chicken breast
• D. Butter

Correct answer: C

Rationale: Chicken breast is a suitable recommendation for a low-cholesterol diet as it is low in cholesterol. Eggs and cheese are high in cholesterol and not suitable for a low-cholesterol diet. Butter is also high in cholesterol and should be avoided in a low-cholesterol diet.

5. A client with gout is being taught about dietary management. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should increase my intake of purine-rich foods.
• B. I should decrease my intake of purine-rich foods.
• C. I should increase my intake of sodium-rich foods.
• D. I should decrease my intake of potassium-rich foods.

Correct answer: B

Rationale: The correct answer is B. Decreasing the intake of purine-rich foods is essential in managing gout as purines break down into uric acid, contributing to gout symptoms. Increasing purine-rich foods would exacerbate the condition by increasing uric acid levels. Therefore, choice A is incorrect. Choices C and D are also incorrect as increasing sodium-rich foods (choice C) is not recommended for gout management, and decreasing potassium-rich foods (choice D) is unrelated to gout.

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