Nursing Elites

1. A client at risk for coronary artery disease seeks advice from a nurse. What should the nurse recommend to reduce the risk?

• A. Increase your intake of saturated fats.
• B. Exercise for 150 minutes per week.
• C. Take iron supplements daily.
• D. Limit fruits and vegetables in your diet.

Correct answer: B

Rationale: The correct recommendation to reduce the risk of coronary artery disease is to exercise for at least 150 minutes per week. Regular exercise is crucial in maintaining cardiovascular health and reducing the chances of developing heart disease. Increasing intake of saturated fats (Choice A) is counterproductive as it can raise cholesterol levels and contribute to arterial plaque formation. Taking iron supplements daily (Choice C) is not directly related to reducing the risk of coronary artery disease. Limiting fruits and vegetables in the diet (Choice D) is also not advisable, as they are essential components of a heart-healthy diet due to their high fiber and nutrient content.

2. A nurse is caring for a 7-month-old infant being treated for severe dehydration. Which finding indicates treatment has been effective?

• A. Skin turgor displays tenting
• B. Flat anterior fontanel
• C. Cool, mottled skin
• D. Hyperpnea

Correct answer: B

Rationale: A flat anterior fontanel indicates improved hydration in infants, as dehydration typically causes sunken fontanels.

3. A nurse is preparing to perform a sterile dressing change for a client with a surgical wound. Which action should the nurse take to prevent contamination during the dressing change?

• A. Proceed with the dressing change
• B. Restart the procedure if the sterile solution splashes onto the sterile field
• C. Continue without concern for minor splashes
• D. Delegate the task to another nurse

Correct answer: B

Rationale: The correct action for the nurse to take to prevent contamination during a sterile dressing change is to restart the procedure if the sterile solution splashes onto the sterile field. Any contamination of the sterile field compromises the aseptic technique and increases the risk of infection for the client. Therefore, it is crucial to maintain the sterility of the field throughout the procedure. Choices A, C, and D are incorrect because proceeding with the dressing change, continuing without concern for minor splashes, or delegating the task to another nurse would all compromise the sterility of the procedure and increase the risk of infection for the client.

4. Which of the following characteristics would indicate true labor in a client?

• A. Contractions are irregular and painless
• B. Fetus moves to an anterior position
• C. Bloody show is not present
• D. Contractions are regular in frequency

Correct answer: D

Rationale: The correct answer is D. True labor is characterized by regular contractions that increase in intensity and frequency. These contractions lead to cervical dilation and effacement, signaling the onset of labor. Choice A is incorrect because true labor contractions are regular and painful, not irregular and painless. Choice B is irrelevant to determining true labor. Choice C is also unrelated as the presence or absence of a bloody show does not definitively indicate true labor.

5. A nurse is caring for a client who has been receiving oxytocin IV for labor augmentation. The client's contractions are occurring every 2 minutes and lasting 90 seconds. What action should the nurse take?

• A. Decrease the oxytocin infusion
• B. Discontinue the oxytocin infusion
• C. Increase the IV fluid rate
• D. Apply an internal fetal monitor

Correct answer: B

Rationale: The correct action for the nurse to take in this situation is to discontinue the oxytocin infusion. The client is experiencing uterine hyperstimulation, as evidenced by contractions occurring every 2 minutes and lasting 90 seconds. Discontinuing the oxytocin is crucial to prevent fetal distress and uterine rupture. Increasing the IV fluid rate would not address the uterine hyperstimulation caused by oxytocin. Applying an internal fetal monitor is not the priority at this moment; first, the oxytocin infusion needs to be stopped to manage the uterine hyperstimulation effectively.

Similar Questions