Nursing Elites

1. The client with chronic kidney disease (CKD) is being educated about dietary modifications. Which dietary restriction should the nurse emphasize the most?

• A. Limit intake of high-fiber foods
• B. Restrict protein intake
• C. Avoid dairy products
• D. Increase fluid intake

Correct answer: B

Rationale: The most crucial dietary restriction to emphasize for a client with chronic kidney disease (CKD) is to restrict protein intake. By restricting protein intake, the workload on the kidneys is reduced, which helps slow the progression of CKD. While high-fiber foods are generally beneficial, they may need to be limited in some individuals with CKD due to potassium concerns, making choice A less critical. Avoiding dairy products may be necessary in some cases to control phosphorus levels, but it is not as vital as restricting protein intake. Increasing fluid intake is essential for kidney health, but it is not the most critical dietary modification for clients with CKD.

2. During a routine prenatal visit, a nurse measures a client’s fundal height at 26 weeks gestation. What should the fundal height be?

• A. Approximately 26 cm
• B. Between 24 to 28 cm
• C. Above the umbilicus by two finger widths
• D. Below the xiphoid process

Correct answer: B

Rationale: The correct answer is B: 'Between 24 to 28 cm.' Fundal height is expected to be approximately equal to the weeks of gestation, so at 26 weeks, the fundal height should typically range between 24 to 28 cm. Choice A is incorrect because fundal height is not an exact measurement of gestational age in centimeters. Choice C is incorrect as it provides a general description above the umbilicus, which is not specific to 26 weeks gestation. Choice D is incorrect as the fundal height would not reach below the xiphoid process at 26 weeks gestation.

3. Which intervention is most effective in preventing the spread of infection in a healthcare setting?

• A. Wearing gloves
• B. Using hand sanitizer
• C. Practicing hand hygiene
• D. Disinfecting surfaces

Correct answer: C

Rationale: Practicing hand hygiene is the most effective measure to prevent the spread of infection in healthcare settings. While wearing gloves, using hand sanitizer, and disinfecting surfaces are important infection control measures, they are not as effective as proper hand hygiene. Hand hygiene, including handwashing with soap and water or using alcohol-based hand sanitizers, is crucial in preventing the transmission of pathogens from one person to another, making it the best choice among the options provided. Wearing gloves primarily protects the wearer and is not a substitute for hand hygiene. Using hand sanitizer is helpful but may not be as effective as proper handwashing. Disinfecting surfaces is important but does not address the direct transmission of pathogens through hand contact, which hand hygiene effectively prevents.

4. What intervention has the highest priority for a client with a fourth-degree midline laceration following the vaginal delivery of an 8-pound 10-ounce infant?

• A. Administer a prescribed stool softener
• B. Administer prescribed PRN sleep medications
• C. Encourage breastfeeding to promote uterine involution
• D. Encourage the use of prescribed analgesic perineal sprays

Correct answer: A

Rationale: Administering a prescribed stool softener is the highest priority intervention for a client with a fourth-degree midline laceration to prevent straining during bowel movements, which could potentially harm the healing laceration. Stool softeners help in maintaining soft stools, reducing the risk of injury to the suture line. Administering PRN sleep medications, encouraging breastfeeding, or promoting the use of analgesic perineal sprays are important aspects of care but are not the priority in this situation. Stool softeners play a crucial role in preventing complications and promoting healing in such cases, making it the most urgent intervention.

5. A client is admitted with a diagnosis of congestive heart failure (CHF). Which intervention is most important to include in the plan of care?

• A. Restrict fluid intake
• B. Provide a high-sodium diet
• C. Encourage vigorous exercise
• D. Administer bronchodilators as prescribed

Correct answer: A

Rationale: The correct answer is A: Restrict fluid intake. Fluid restriction is crucial in the management of congestive heart failure (CHF) as it helps prevent fluid overload, which can exacerbate CHF symptoms. Choices B, C, and D are incorrect. Providing a high-sodium diet would worsen fluid retention and increase the workload of the heart. Encouraging vigorous exercise can strain the heart further in CHF patients. Administering bronchodilators is not the priority intervention for CHF.

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