Nursing Elites

1. The nurse has provided dietary instructions to the mother of a child with celiac disease. The nurse determines that further instruction is needed if the mother states that she will include which food item in the child's nutritional plan?

• A. Corn
• B. Chicken
• C. Oatmeal
• D. Vitamin supplements

Correct answer: C

Rationale: In celiac disease, individuals need to avoid gluten-containing foods like wheat, rye, barley, and oats. Oatmeal contains gluten unless it is specifically labeled as gluten-free. Corn and rice are safe alternatives for individuals with celiac disease as they do not contain gluten. Chicken is a naturally gluten-free protein source. While vitamin supplements may be necessary to address deficiencies due to malabsorption, oatmeal poses a risk of gluten exposure, making it an incorrect choice for a child with celiac disease.

2. A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient?

• A. Deep breathing techniques to increase oxygen levels.
• B. Cough regularly and deeply to clear airway passages.
• C. Cough following bronchodilator utilization.
• D. Decrease CO2 levels by increasing oxygen intake during meals.

Correct answer: C

Rationale: The correct answer is to instruct the patient to cough following bronchodilator utilization. In COPD and PVD patients, bronchodilators help to open up the airways, making coughing more effective in clearing secretions from the lungs. This instruction can aid in improving the patient's ability to breathe by enhancing airway clearance. Deep breathing techniques (Choice A) may help increase oxygen levels but may not directly address the patient's immediate concern of breathing difficulty. Coughing regularly and deeply (Choice B) can be beneficial, but the timing following bronchodilator use is more crucial to maximize its effectiveness. Decreasing CO2 levels by increasing oxygen intake during meals (Choice D) does not directly address the patient's concern about breathing ease or the role of bronchodilators in improving cough effectiveness.

3. An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

• A. Arrange for a friend to administer the medication on schedule.
• B. Give the patient written instructions about how to take the medications.
• C. Teach the patient about the high risk for infecting others unless treatment is followed.
• D. Arrange for a daily noon meal at a community center where the drug will be administered

Correct answer: D

Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen for a homeless patient with active tuberculosis. By arranging a daily noon meal at a community center where the drug will be administered, the nurse ensures that the patient is available to receive the medication and can directly observe the patient taking it. This method helps address the challenges faced by homeless individuals, such as lack of a stable living situation. The other options, such as having a friend administer the medication, giving written instructions, or educating about infecting others, may not be as effective in ensuring adherence, especially in the case of a homeless individual with alcoholism.

4. A patient's chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute?

• A. Decreased HR
• B. Paresthesias
• C. Muscle weakness of the extremities
• D. Migraines

Correct answer: D

Rationale: The correct answer is 'Migraines.' Migraines are not a symptom typically associated with hyperkalemia. In acute hyperkalemia, one would not expect to see migraines. Symptoms of hyperkalemia often include muscle weakness, paresthesias, and cardiac manifestations such as bradycardia or even cardiac arrest. Therefore, choices A, B, and C are more commonly associated with acute hyperkalemia compared to migraines, making it the correct choice.

5. The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for lung cancer. Which information should the nurse include about the patient's postoperative care?

• A. Positioning on the right side
• B. Bed rest for the first 24 hours
• C. Frequent use of an incentive spirometer
• D. Chest tube placement with continuous drainage

Correct answer: C

Rationale: After a pneumonectomy, frequent deep breathing and coughing are essential to prevent atelectasis and promote gas exchange. Patients are typically positioned on the surgical side to aid in gas exchange. Early mobilization is crucial to reduce the risk of postoperative complications such as pneumonia and deep vein thrombosis. While chest tubes may or may not be placed in the surgical space, if used, they are clamped and only adjusted by the surgeon to manage serosanguineous fluid accumulation. Overfilling of the chest cavity can compromise remaining lung function and cardiovascular status. Chest x-rays are useful for monitoring fluid volume and space postoperatively. Therefore, the correct postoperative care instruction for the patient undergoing a left pneumonectomy is the frequent use of an incentive spirometer. Choices A, B, and D are incorrect as positioning on the right side, bed rest for the first 24 hours, and continuous chest tube drainage are not standard postoperative care practices for patients undergoing pneumonectomy.

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