Nursing Elites

1. A client has a new diagnosis of renal calculi, and the nurse is teaching about dietary management. Which of the following statements should the nurse include in the teaching?

• A. You should increase your intake of calcium-rich foods.
• B. You should decrease your intake of calcium-rich foods.
• C. You should increase your intake of sodium-rich foods.
• D. You should decrease your intake of potassium-rich foods.

Correct answer: B

Rationale: The correct answer is to decrease the intake of calcium-rich foods when managing renal calculi. Calcium can contribute to the formation of stones in the kidneys, so reducing its intake can help prevent the development of new calculi and manage existing ones.

2. A client has major fecal incontinence and reports irritation in the perianal area. Which of the following actions should the nurse take first?

• A. Apply a fecal collection system
• B. Apply a barrier cream
• C. Cleanse and dry the area
• D. Check the client's perineum

Correct answer: D

Rationale: When a client with major fecal incontinence reports irritation in the perianal area, the nurse's initial action should be to assess the client's perineum to gather more information. By checking the perineum, the nurse can identify the extent and nature of the irritation, allowing for appropriate interventions to be initiated. This assessment is crucial in developing a comprehensive care plan and addressing the client's immediate needs effectively. Applying the nursing process priority-setting framework helps in planning care and prioritizing nursing actions, making assessment the initial step in this scenario. Applying a fecal collection system (choice A) would be premature without assessing the perineal area first. Similarly, applying a barrier cream (choice B) or cleansing and drying the area (choice C) should follow the assessment to ensure appropriate interventions are chosen based on the assessment findings.

3. A client has a new prescription for a low-sodium diet. Which of the following foods should the nurse recommend?

• A. Pickles
• B. Canned soup
• C. Fresh fruits
• D. Smoked salmon

Correct answer: C

Rationale: Fresh fruits are naturally low in sodium, making them a suitable choice for a low-sodium diet. They provide essential nutrients and are a healthy option for individuals who need to limit their sodium intake. Pickles (Choice A) and canned soup (Choice B) are typically high in sodium and should be avoided in a low-sodium diet. Smoked salmon (Choice D) is also usually high in sodium due to the smoking process, so it is not a recommended choice for a low-sodium diet.

4. A healthcare professional is assessing a client who has chronic pain. Which of the following findings should the healthcare professional expect?

• A. Hypotension
• B. Tachycardia
• C. Hyperthermia
• D. Depression

Correct answer: D

Rationale: The correct answer is D: Depression. Chronic pain is often associated with psychological effects like depression. Patients with chronic pain may experience feelings of hopelessness, helplessness, and despair, which are characteristic of depression. While chronic pain can lead to changes in vital signs like increased blood pressure and heart rate, hypotension, tachycardia, or hyperthermia are not typically expected findings solely due to chronic pain. Therefore, the healthcare professional should be alert to signs of depression in clients with chronic pain and address these psychological impacts appropriately.

5. When preparing to insert an NG tube for a client who requires gastric decompression, which of the following actions should the nurse take?

• A. Position the client with the head of the bed elevated to 30° prior to insertion
• B. Measure the tube from the client's nose to the earlobe to the xiphoid process
• C. Lubricate the entire length of the tube with water-soluble lubricant
• D. Instruct the client to cough during insertion

Correct answer: B

Rationale: Measuring the tube from the client's nose to the earlobe to the xiphoid process ensures the tube is inserted to the correct depth. This measurement helps prevent complications such as tube misplacement or lung insertion. Positioning the client with the head of the bed elevated to 30° is important to facilitate easier insertion but is not the most crucial step. Lubricating the entire length of the tube with water-soluble lubricant is essential for smooth insertion but is not the most critical action. Instructing the client to cough during insertion is not necessary and may lead to unnecessary discomfort.

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