Nursing Elites

1. A client with nephropathy secondary to diabetes mellitus is receiving dietary teaching from a nurse and plans to make dietary adjustments. Which of the following instructions should the nurse include?

• A. Consume less than 45% of total calories from carbohydrates per day.
• B. Eat no more than 300 mg of cholesterol per day.
• C. Consume less than 0.8 g/kg of body weight of protein per day.
• D. Eat at least 45 g of fiber per day.

Correct answer: D

Rationale: For a client with nephropathy secondary to diabetes mellitus, increasing fiber intake is essential as it can help manage blood sugar levels and improve overall bowel health. Choice A is incorrect because carbohydrates should be controlled but not limited to less than 45% of total calories. Choice B is incorrect as the recommended daily cholesterol intake for individuals with diabetes is less than 200 mg. Choice C is incorrect as protein intake should be individualized based on the client's condition and should not be limited to less than 0.8 g/kg of body weight per day.

2. Who most often prescribes a patient's diet order?

• A. Registered Nurse
• B. Physician
• C. Registered Dietetic Technician
• D. Occupational Therapist

Correct answer: B

Rationale: A patient's dietary order is most frequently prescribed by a physician. This is because the physician has a comprehensive understanding of the patient's medical condition and can thus determine the most suitable dietary plan. Registered dietitians often collaborate with physicians in this process, but the final prescription is made by the physician. Although registered nurses, dietetic technicians, and occupational therapists play significant roles in patient care, they typically do not prescribe diet orders.

3. A nurse is providing dietary teaching for a client who has just learned that she has type 2 diabetes mellitus. The nurse should explain that which of the following sweeteners will add calories to the client's carbohydrate count?

• A. Sorbitol
• B. Sucralose
• C. Aspartame
• D. Acesulfame potassium

Correct answer: A

Rationale: Sorbitol is a sweetener that will add calories to the client's carbohydrate count. It is a sugar alcohol that provides about 2.6 calories per gram. Sucralose, aspartame, and acesulfame potassium are all non-nutritive sweeteners that do not contribute significant calories to the diet. Sucralose is about 600 times sweeter than sucrose but does not add calories. Aspartame is a low-calorie sweetener that is approximately 200 times sweeter than sucrose, and acesulfame potassium is a calorie-free sweetener.

4. An adolescent client has bloodshot eyes, a voracious appetite, and dry mouth. Which drug abuse would the nurse most likely suspect?

• A. Marijuana
• B. Amphetamines
• C. Barbiturates
• D. Anxiolytics

Correct answer: A

Rationale: The symptoms described, including bloodshot eyes, a voracious appetite, and dry mouth, are consistent with marijuana use. Bloodshot eyes are a common side effect of marijuana due to its effect on blood vessels in the eyes. Marijuana also often causes an increase in appetite (known as 'the munchies') and can result in dry mouth. Amphetamines typically cause symptoms like increased alertness, energy, and decreased appetite. Barbiturates and anxiolytics would not typically cause bloodshot eyes, a voracious appetite, and dry mouth as described in the scenario. Therefore, the most likely drug abuse the nurse would suspect in this case is marijuana.

5. A client who is breastfeeding is being taught diet modification by a nurse. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should drink an 8-ounce glass of water each time my baby nurses.
• B. I should take a 1500-milligram iron supplement daily.
• C. I can eat a 2500-calorie daily diet to lose 1 lb per week.
• D. I can eat ounces of swordfish daily.

Correct answer: A

Rationale: The correct answer is A because drinking an 8-ounce glass of water each time the baby nurses helps maintain hydration and support milk production. Choice B is incorrect as the need for iron supplementation should be discussed with a healthcare provider. Choice C is incorrect as a 2500-calorie diet is not typically recommended for weight loss during breastfeeding. Choice D is incorrect as consuming high levels of swordfish is not advisable due to its mercury content, which can be harmful to the baby.

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