Nursing Elites

1. A client is being taught about which foods to include in a low fiber diet. Which statement indicates understanding?

• A. Choosing a fresh pear would be a good snack option
• B. I should make refried beans for supper
• C. Selecting white rice as a side dish is a good choice
• D. Opting for bran cereal would be a good breakfast choice

Correct answer: C

Rationale: The correct answer is C because white rice is a low-fiber food suitable for a low-fiber diet, making it an appropriate choice. Choices A, B, and D are incorrect because fresh pear, refried beans, and bran cereal are high-fiber foods and not suitable for a low-fiber diet.

2. A nurse delegates a position change to a nursing assistive personnel. The nurse instructs the assistive personnel (AP) to place the patient in the lateral position. Which finding by the nurse indicates a correct outcome?

• A. Patient is lying semiprone.
• B. Patient is lying on side.
• C. Patient is lying on abdomen.
• D. Patient is lying on back.

Correct answer: B

Rationale: The correct answer is B because the lateral position means lying on the side with body weight on the dependent hip and shoulder. Choice A is incorrect as 'semiprone' means lying on the abdomen with one leg flexed. Choice C is incorrect as 'prone' means lying face down. Choice D is incorrect as 'supine' means lying on the back.

3. A nurse is preparing to administer verapamil to a client who is 2 days postmyocardial infarction. The nurse should monitor the client for which of the following outcomes as a therapeutic response to the medication?

• A. Decreased blood pressure
• B. Decreased anginal pain
• C. Decreased heart rate
• D. Decreased anxiety

Correct answer: B

Rationale: The correct answer is B: Decreased anginal pain. Verapamil is a calcium channel blocker used to relieve angina by reducing myocardial oxygen demand. Monitoring for decreased anginal pain is essential as it indicates a therapeutic response to the medication. Choices A, C, and D are incorrect as verapamil's primary goal in this context is not to decrease blood pressure, heart rate, or anxiety.

4. The patient has been in bed for several days and needs to be ambulated. What action should the nurse take first?

• A. Dangle the patient at the bedside.
• B. Encourage isometric exercises.
• C. Suggest a high-calcium diet.
• D. Maintain a narrow base of support.

Correct answer: A

Rationale: The correct answer is A: 'Dangle the patient at the bedside.' When a patient has been in bed for an extended period and needs to be ambulated, it is essential to dangle the patient at the bedside first. Dangling involves helping the patient sit on the edge of the bed with their legs over the side before standing up. This action helps prevent orthostatic hypotension, a sudden drop in blood pressure when moving from lying down to standing up, which can lead to dizziness or fainting. Encouraging isometric exercises (choice B) or suggesting a high-calcium diet (choice C) are not the first actions to take before ambulating a patient. Maintaining a narrow base of support (choice D) is related to assisting with ambulation but is not the initial step that should be taken.

5. A client with a history of seizures is admitted for monitoring. What should the nurse prioritize?

• A. Ensure the client is on seizure precautions.
• B. Educate the client about seizure triggers.
• C. Monitor for signs of an impending seizure.
• D. Initiate IV access for anti-seizure medication.

Correct answer: A

Rationale: The correct answer is to ensure the client is on seizure precautions. This is crucial in preventing injury during a seizure episode. While educating the client about seizure triggers (choice B) is important for long-term management, it is not the priority when the client is admitted for monitoring. Monitoring for signs of an impending seizure (choice C) is essential but does not address immediate safety concerns. Initiating IV access for anti-seizure medication (choice D) is not the priority unless a seizure occurs and medical intervention is needed.

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