Nursing Elites

1. A client with type 1 diabetes mellitus is being taught self-administration of insulin by a nurse. Which of the following instructions should the nurse include?

• A. Inject air into the vial before withdrawing the insulin.
• B. Draw up the short-acting insulin first, then the long-acting insulin.
• C. Store unopened insulin vials in the freezer.
• D. Rotate injection sites within the same anatomical region.

Correct answer: D

Rationale: The correct instruction the nurse should include is to rotate injection sites within the same anatomical region. This practice helps reduce the risk of lipodystrophy, a condition characterized by fatty tissue changes due to repeated insulin injections in the same spot. By rotating sites, the client ensures better insulin absorption and prevents localized skin changes. Injecting air into the vial before withdrawing insulin (Choice A) is unnecessary and not recommended. Drawing up short-acting insulin before long-acting insulin (Choice B) is not a standard practice and can lead to errors in dosing. Storing unopened insulin vials in the freezer (Choice C) is incorrect as insulin should be stored in the refrigerator, not the freezer, to maintain its effectiveness.

2. A client is postoperative following a hip arthroplasty. Which of the following interventions should the nurse include in the plan of care?

• A. Encourage the client to lie flat in bed.
• B. Apply heat to the incision site.
• C. Use an abduction pillow between the client's legs.
• D. Place a trochanter roll under the client's knees.

Correct answer: C

Rationale: Using an abduction pillow between the client's legs is essential in maintaining proper alignment and preventing dislocation of the hip joint following a hip arthroplasty. Encouraging the client to lie flat in bed (Choice A) is not recommended as early mobilization is crucial for preventing complications. Applying heat to the incision site (Choice B) is not typically done immediately postoperatively. Placing a trochanter roll under the client's knees (Choice D) is not as beneficial as using an abduction pillow to maintain proper positioning.

3. A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

• A. Arrange for an ethics committee meeting to address the family's concerns
• B. Support the family's decision and initiate life-sustaining measures
• C. Complete an incident report
• D. Encourage the family to contact an attorney

Correct answer: A

Rationale: In this scenario, the nurse should arrange for an ethics committee meeting to address the family's concerns while ensuring the client's wishes are respected. Choosing option A allows for a formal discussion involving healthcare professionals, family members, and possibly a legal expert to navigate the situation ethically and legally. Supporting the family's decision to initiate life-sustaining measures (option B) would disregard the client's advance directives and autonomy. Completing an incident report (option C) is not appropriate in this situation as it does not address the conflict of interest between the family's desires and the client's wishes. Encouraging the family to contact an attorney (option D) may escalate the situation unnecessarily before exploring more ethical and collaborative approaches.

4. A nurse is providing dietary teaching to a client who has a new diagnosis of celiac disease. Which of the following foods should the nurse instruct the client to avoid?

• A. Rice
• B. Barley soup
• C. Cornbread
• D. Potatoes

Correct answer: B

Rationale: The correct answer is B: Barley soup. Barley contains gluten, which is harmful to individuals with celiac disease. Therefore, the nurse should instruct the client to avoid barley-containing foods like barley soup. Choices A, C, and D are safe options for individuals with celiac disease as they do not contain gluten. Rice, cornbread, and potatoes are gluten-free and can be included in the client's diet.

5. A client who has a new prescription for omeprazole is being taught by a nurse. Which of the following client statements indicates an understanding of the teaching?

• A. I should take this medication before meals.
• B. I should take this medication with an antacid.
• C. I should avoid taking this medication at bedtime.
• D. I should take this medication with food.

Correct answer: A

Rationale: The correct answer is A. Taking omeprazole before meals is important as it improves the medication's effectiveness in reducing gastric acid production. Option B is incorrect as omeprazole should not be taken with antacids as it can interfere with its absorption. Option C is incorrect because omeprazole is usually recommended to be taken before breakfast, not at bedtime. Option D is incorrect as omeprazole is generally taken on an empty stomach, at least 1 hour before a meal.

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