Nursing Elites

1. The nurse is teaching a client about lifestyle changes to manage hypertension. Which of the following should be emphasized?

• A. Increase daily intake of sodium.
• B. Exercise regularly and maintain a healthy weight.
• C. Reduce intake of potassium-rich foods.
• D. Drink alcohol in moderation.

Correct answer: B

Rationale: The correct answer is B. Regular exercise and maintaining a healthy weight are crucial lifestyle changes in managing hypertension. Exercise helps lower blood pressure and improves heart health, while maintaining a healthy weight reduces the risk of hypertension. Choices A, C, and D are incorrect. Increasing daily intake of sodium can elevate blood pressure, reducing intake of potassium-rich foods is not recommended as potassium helps lower blood pressure, and drinking alcohol should be limited or avoided as it can raise blood pressure.

2. Which activity is most important for a client recovering from a hip replacement to avoid during the first few weeks of recovery?

• A. Sitting in a chair for short periods
• B. Crossing the legs while sitting
• C. Walking with assistance
• D. Performing light stretching exercises

Correct answer: B

Rationale: The correct answer is B: Crossing the legs while sitting. Cross-leg position after a hip replacement can significantly increase the risk of hip dislocation. During the first few weeks of recovery, it is crucial for clients to avoid crossing their legs to protect the new joint. Choices A, C, and D are not as critical during the initial recovery phase. Sitting in a chair for short periods, walking with assistance, and performing light stretching exercises are generally encouraged activities that can help in the recovery process without posing a significant risk of complications like hip dislocation.

3. Which statement made by the client indicates an understanding of the instructions regarding the administration of alendronate (Fosamax)?

• A. I will take the medication at bedtime to avoid stomach upset.
• B. I will take the medication with a full glass of water first thing in the morning.
• C. I will lie down for 30 minutes after taking the medication.
• D. I will take the medication with food to reduce stomach irritation.

Correct answer: B

Rationale: The correct answer is B. Alendronate (Fosamax) should be taken with a full glass of water in the morning to prevent esophageal irritation and ensure proper absorption. Choice A is incorrect because taking alendronate at bedtime increases the risk of esophageal irritation due to lying down. Choice C is incorrect because patients should remain upright for at least 30 minutes after taking alendronate to prevent esophageal irritation. Choice D is incorrect because alendronate should be taken on an empty stomach, not with food, to enhance absorption.

4. After repositioning an immobile client, the nurse observes an area of hyperemia. What action should the nurse take to assess for blanching?

• A. Document the presence in the client’s record.
• B. Apply light pressure over the area.
• C. Apply heat to the area and reassess in 30 minutes.
• D. Apply cold compresses to reduce the redness.

Correct answer: B

Rationale: The correct action for the nurse to take to assess for blanching in an area of hyperemia is to apply light pressure over the area. Blanching is the temporary whitening of the skin when pressure is applied and then released, indicating that the blood flow is returning to the area. Applying light pressure helps in determining if the hyperemic area blanches, ensuring that blood flow is adequate. Choices A, C, and D are incorrect because documenting findings, applying heat, or using cold compresses are not appropriate actions for assessing blanching in an area of hyperemia.

5. A client with a fractured femur is placed in skeletal traction. What action should the nurse prioritize?

• A. Ensure that the weights are freely hanging.
• B. Place pillows under the client's knees.
• C. Adjust the weights to alleviate discomfort.
• D. Ensure that the traction ropes are free of knots.

Correct answer: A

Rationale: The correct action the nurse should prioritize when a client is placed in skeletal traction for a fractured femur is to ensure that the weights are freely hanging. This is crucial to maintain proper alignment of the bone and prevent complications. Placing pillows under the client's knees (Choice B) is not a priority in skeletal traction. Adjusting the weights to alleviate discomfort (Choice C) should not be done without proper orders from the healthcare provider. Ensuring that the traction ropes are free of knots (Choice D) is important but ensuring the weights hang freely is the priority to maintain traction effectiveness.

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