Nursing Elites

1. A nurse is providing teaching about formula feeding to the parents of an infant. Which of the following instructions should the nurse include?

• A. Formula that remains in the bottle should be used for one more feeding.
• B. Formula should be changed to whole milk when the infant is 9 months old.
• C. If the infant is gaining weight too rapidly, dilute the formula.
• D. If the infant turns away after taking most of the feeding, stop the feeding.

Correct answer: D

Rationale: If the infant turns away after taking most of the feeding, it indicates they are full, and continuing to feed may lead to overfeeding.

2. A nurse is preparing to administer a gavage feeding via nasogastric tube to a preterm newborn who is receiving supplemental oxygen. Which of the following actions should the nurse take?

• A. Stabilize the tube with tape to the newborn’s forehead.
• B. Remove supplemental oxygen during the feeding.
• C. Measure the stomach aspirate prior to the feeding.
• D. Place the newborn on her left side for 30 min after the feeding.

Correct answer: C

Rationale: Measuring the stomach aspirate prior to the feeding is essential to ensure proper placement and function of the NG tube.

3. A nurse is reviewing the laboratory findings of a client who has heart failure. Which of the following findings indicates that the client is experiencing fluid volume excess?

• A. BUN 8 mg/dL
• B. Hgb 15 g/dL
• C. Creatinine 0.8 mg/dL
• D. Sodium 140 mEq/L

Correct answer: A

Rationale: A BUN level of 8 mg/dL is indicative of fluid volume excess, which is common in clients with heart failure.

4. A nurse is planning care for a client who reports increasing difficulty swallowing food. Which of the following interventions should the nurse plan to take?

• A. Turn on the client’s television during meals.
• B. Place the client into a semi-reclining position for meals.
• C. Encourage the client to rest prior to mealtimes.
• D. Encourage the client to use a straw when drinking liquids.

Correct answer: C

Rationale: Encouraging the client to rest prior to mealtimes can help reduce fatigue and improve the ability to swallow.

5. A nurse is developing a plan of care for a client who has anorexia nervosa. Which of the following actions should the nurse include in the plan?

• A. Encourage the client to participate in developing a system of rewards.
• B. Arrange for someone to remain with the client for 30 min after meals
• C. Offer the client a selection of beverages at each meal.
• D. Inform the client that a weight gain of 2.3 kg per week is expected.

Correct answer: A

Rationale: Encouraging the client to participate in developing a system of rewards can help motivate and engage them in their treatment plan.

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