Nursing Elites

1. A client with chronic kidney disease is being educated by a nurse about managing their condition. Which of the following statements shows an understanding of the teaching?

• A. I will need to take an iron supplement.
• B. I will consume foods high in phosphorus.
• C. I will reduce my intake of carbohydrates.
• D. I will monitor my blood glucose level daily.

Correct answer: A

Rationale: The correct answer is A. Clients with chronic kidney disease often develop anemia due to reduced erythropoietin production, leading to decreased red blood cell production. Iron supplementation is frequently required to enhance red blood cell production. Choices B, C, and D are incorrect because in chronic kidney disease, there is a need to restrict phosphorus intake, control carbohydrate intake for blood sugar management, and monitor electrolytes and fluid balance rather than blood glucose levels.

2. A nurse is assessing a client for signs of heart failure. Which of the following findings should the nurse monitor?

• A. Decreased heart rate
• B. Peripheral edema
• C. Increased energy levels
• D. Hyperglycemia

Correct answer: B

Rationale: The correct answer is B: Peripheral edema. Peripheral edema, the accumulation of fluid causing swelling in the extremities, is a classic sign of heart failure due to fluid overload. This occurs because the heart's reduced pumping efficiency leads to fluid backup in the circulatory system. Choices A, C, and D are incorrect. Decreased heart rate is not typically associated with heart failure; instead, tachycardia or an increased heart rate may be observed. Increased energy levels are not an expected finding in heart failure, as this condition often causes fatigue and weakness. Hyperglycemia is not a direct sign of heart failure; however, it can be present in individuals with uncontrolled diabetes or as a result of certain treatments, but it is not a specific indicator of heart failure.

3. A healthcare professional is assessing a client with hepatic encephalopathy. Which of the following foods indicates understanding of dietary teaching?

• A. Cottage cheese
• B. Tuna salad
• C. Rice with black beans
• D. Three-egg omelet

Correct answer: C

Rationale: The correct answer is C: 'Rice with black beans.' Plant-based proteins such as beans are recommended for clients with hepatic encephalopathy to reduce ammonia production from animal proteins. Cottage cheese (choice A), tuna salad (choice B), and a three-egg omelet (choice D) are high in animal proteins, which can contribute to increased ammonia levels in hepatic encephalopathy, making them less suitable dietary choices for these clients.

4. A nurse is teaching a client with newly diagnosed hypertension about lifestyle changes. Which of the following recommendations should the nurse make?

• A. Limit sodium intake to 3,000 mg per day.
• B. Exercise for at least 30 minutes most days of the week.
• C. Drink no more than two alcoholic drinks per day.
• D. Increase fluid intake to at least 3 liters per day.

Correct answer: B

Rationale: The correct answer is B: 'Exercise for at least 30 minutes most days of the week.' Regular exercise, especially aerobic activity, is known to help lower blood pressure and should be included in lifestyle changes for managing hypertension. Choice A is incorrect because the recommended sodium intake for individuals with hypertension is usually lower than 3,000 mg per day. Choice C is incorrect as it is advisable to limit alcohol intake to one drink per day for women and two drinks per day for men. Choice D is incorrect because increasing fluid intake to 3 liters per day may not be necessary and could be harmful in some cases, depending on the individual's health status.

5. A nurse is assessing a client 1 hour after birth and notes a boggy uterus located 2 cm above the umbilicus. What should the nurse do first?

• A. Take vital signs
• B. Assess lochia
• C. Massage the fundus
• D. Give oxytocin IV bolus

Correct answer: C

Rationale: A boggy uterus located 2 cm above the umbilicus suggests uterine atony, which is a common cause of postpartum hemorrhage. The initial intervention in this situation is to massage the fundus. Fundal massage helps the uterus contract, promoting hemostasis and preventing excessive bleeding. Taking vital signs or assessing lochia are important actions but are secondary to addressing uterine atony. Administering oxytocin IV bolus is often done after fundal massage to further enhance uterine contractions.

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