Nursing Elites

1. A client has a new diagnosis of lactose intolerance and is receiving teaching from a nurse about dietary management. Which of the following statements should the nurse include in the teaching?

• A. You should avoid foods that contain lactose.
• B. You should increase your intake of high-fiber foods.
• C. You should avoid foods that contain gluten.
• D. You should increase your intake of dairy products.

Correct answer: A

Rationale: The correct statement for the nurse to include in teaching a client with lactose intolerance is to avoid foods that contain lactose. Lactose intolerance results from the body's inability to digest lactose, a sugar found in dairy products. By avoiding foods containing lactose, the client can manage symptoms and prevent complications associated with lactose intolerance. Choices B, C, and D are incorrect. Increasing intake of high-fiber foods (choice B) may be beneficial for general health but is not directly related to lactose intolerance. Avoiding gluten (choice C) is necessary for individuals with celiac disease, not lactose intolerance. Increasing intake of dairy products (choice D) would worsen symptoms in individuals with lactose intolerance due to the lactose content.

2. When should discharge planning begin for a client admitted to a long-term care facility for rehabilitation after a total hip arthroplasty?

• A. One week prior to the client's discharge
• B. Upon the client's admission to the care facility
• C. Once the discharge date is identified
• D. When the client addresses the topic with the nurse

Correct answer: B

Rationale: Discharge planning should begin upon the client's admission to the care facility. This early start allows the healthcare team to conduct assessments, set goals, and coordinate services for a smooth transition back home or to the community. Initiating discharge planning early ensures timely arrangements, leading to optimal outcomes and continuity of care. Choices A, C, and D are incorrect because waiting until one week before discharge, after the discharge date is identified, or until the client brings up the topic may lead to rushed decision-making, inadequate arrangements, and a less effective transition process.

3. A client has a new prescription for total parenteral nutrition (TPN). Which of the following actions should the nurse plan to take?

• A. Obtain a random blood glucose daily.
• B. Change the IV tubing every 72 hours.
• C. Apply a new dressing to the IV site every 24 hours.
• D. Weigh the client weekly.

Correct answer: A

Rationale: When a client is on total parenteral nutrition (TPN), monitoring blood glucose levels daily is crucial to manage and detect complications like hyperglycemia, which can occur due to the high glucose content in TPN solutions. Regular blood glucose monitoring helps the healthcare team adjust the TPN infusion rate to maintain optimal glucose levels and prevent adverse events. Choices B, C, and D are incorrect because changing IV tubing every 72 hours, applying a new dressing to the IV site every 24 hours, and weighing the client weekly are not specific actions directly related to monitoring and managing the effects of TPN, particularly in relation to glucose levels.

4. In an emergency department, a provider is assessing a client with an acute head injury following a motor-vehicle crash. Which of the following findings should be prioritized?

• A. A Glasgow Coma Scale score of 13
• B. Clear fluid leaking from the nose
• C. Nausea and vomiting
• D. Anisocoria

Correct answer: B

Rationale: The priority finding is the clear fluid leaking from the nose, which could indicate a cerebrospinal fluid leak and potential brain injury. This requires immediate attention to assess for possible cerebrospinal fluid leak, which is a serious complication of head trauma and needs prompt intervention to prevent further complications. While a Glasgow Coma Scale score of 13 may indicate a mild alteration in consciousness, it is not as urgent as assessing for a cerebrospinal fluid leak. Nausea and vomiting are common symptoms after head injuries but do not take precedence over assessing for a potential cerebrospinal fluid leak. Anisocoria (unequal pupils) is also important to note but is not as urgent as identifying a possible cerebrospinal fluid leak in this scenario.

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

• A. I should avoid drinking milk.
• B. I should avoid drinking coffee.
• C. I should avoid eating high-fiber foods.
• D. I should avoid eating low-fat foods.

Correct answer: B

Rationale: The correct answer is B. Avoiding coffee is important in managing peptic ulcer disease as it helps reduce acid production and alleviate symptoms. Coffee is known to stimulate acid secretion in the stomach, which can exacerbate ulcer symptoms. Therefore, instructing the client to avoid drinking coffee is essential in the dietary management of peptic ulcer disease. Choices A, C, and D are incorrect. Drinking milk is generally allowed and can even provide a protective effect against ulcers. High-fiber foods are beneficial for digestion and do not need to be avoided unless they cause discomfort. Low-fat foods are also typically recommended for individuals with peptic ulcer disease as they are easier on the digestive system.

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