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. Can bacterial plaque metabolize sucrose, lactose, and fructose? Is fructose, also known as levulose and found naturally in honey, less cariogenic than sucrose and lactose?

• A. Yes, bacterial plaque can metabolize these sugars, but no, fructose is not less cariogenic.
• B. No, bacterial plaque cannot metabolize these sugars, and fructose is not less cariogenic.
• C. Yes, bacterial plaque can metabolize these sugars, but no, fructose is not less cariogenic.
• D. No, bacterial plaque cannot metabolize these sugars, but yes, fructose is less cariogenic.

Correct answer: A

Rationale: The first statement is correct as bacterial plaque can indeed metabolize sucrose, lactose, and fructose. However, the second statement is inaccurate. Fructose, despite being found naturally in honey and known also as levulose, is not less cariogenic than either sucrose or lactose. This means that its consumption does not result in fewer cavities or tooth decay. Therefore, the correct answer is that bacterial plaque can metabolize these sugars, but fructose is not less cariogenic. Choices B, C, and D are incorrect because they either wrongly assert that bacterial plaque cannot metabolize these sugars or wrongly claim that fructose is less cariogenic.

3. Which of the following actions would be of highest priority with regards to the external shunt?

• A. Avoid taking blood pressure or blood sample from the arm with the shunt
• B. Instruct the patient not to exercise the arm with the shunt
• C. Heparinize the shunt daily
• D. Change the dressing of the shunt daily

Correct answer: C

Rationale: Heparinizing the shunt daily (choice C) is the highest priority action as it prevents the formation of blood clots that can occlude the shunt, leading to potential complications such as thrombosis. Avoiding taking blood pressure or blood samples from the arm with the shunt (choice A) is also important, but secondary to heparinizing the shunt. Similarly, instructing the patient not to exercise the arm with the shunt (choice B) can help prevent unnecessary strain on the shunt, but it is not as critical as preventing clot formation. Changing the dressing of the shunt daily (choice D) is a standard nursing care practice to prevent infection, but again, it is not as critical as ensuring the shunt remains patent through daily heparinization.

4. Each is a characteristic manifestation of necrotizing ulcerative gingivitis (NUG), except one. Which is the exception?

• A. Gingival erythema
• B. Necrosis of interdental papilla
• C. Marasmus
• D. Metallic taste and foul odor

Correct answer: C

Rationale: The correct answer is C: Marasmus. Marasmus is a form of severe malnutrition and is not a direct manifestation of necrotizing ulcerative gingivitis (NUG). Choices A, B, and D are all characteristic manifestations of NUG. Gingival erythema, necrosis of interdental papilla, and metallic taste with foul odor are commonly associated with NUG due to the inflammatory and necrotic nature of the condition.

5. A nurse is teaching a group of clients who are at risk for heart disease about decreasing saturated fats in their diet. Which of the following fats should the nurse recommend the clients use when cooking?

• A. Palm oil
• B. Peanut oil
• C. Canola oil
• D. Stick margarine

Correct answer: C

Rationale: Canola oil is lower in saturated fats compared to palm oil, peanut oil, and stick margarine, making it a healthier option for clients at risk for heart disease. Palm oil is high in saturated fats, peanut oil has a moderate amount of saturated fats, and stick margarine is also high in saturated fats and trans fats, which are not heart-healthy choices.

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