Nursing Elites

1. When observing a newly admitted elderly client with dementia resisting care, what approach should the nurse take to facilitate cooperation?

• A. Use short, simple sentences and maintain a calm demeanor
• B. Involve family members to provide reassurance
• C. Offer choices to empower the client
• D. All of the above

Correct answer: D

Rationale: When dealing with a newly admitted elderly client with dementia who is resistant to care, it is crucial to employ multiple strategies to facilitate cooperation. Using short, simple sentences and maintaining a calm demeanor can help the client better understand instructions and reduce agitation. Involving family members can provide comfort and reassurance to the client, potentially decreasing resistance. Offering choices allows the client to feel a sense of control and autonomy in their care, which can increase cooperation and reduce challenging behaviors. Therefore, a combination of clear communication, family involvement, and providing choices is essential to effectively engage and care for a client with dementia. Choices A, B, and C all play crucial roles in addressing the needs of the client, making 'All of the above' the correct answer.

2. The client has chronic renal failure. What dietary modification is most important for this client?

• A. Increase protein intake
• B. Limit potassium-rich foods
• C. Increase sodium intake
• D. Encourage dairy products

Correct answer: B

Rationale: Limiting potassium-rich foods is crucial in chronic renal failure to prevent hyperkalemia, which can lead to cardiac complications. Excessive protein intake can increase the workload on the kidneys and may result in the accumulation of uremic toxins. Increasing sodium intake is generally discouraged in chronic renal failure due to its association with hypertension and fluid retention. Encouraging dairy products may not be suitable for all clients with chronic renal failure, as they are a significant source of phosphorus, which needs to be limited in renal failure to prevent mineral imbalances.

3. After receiving a report, the nurse receives the laboratory values for four clients. Which client requires the nurse’s immediate intervention? The client who is...

• A. Short of breath after a shower and has a hemoglobin of 8 grams
• B. Bleeding from a finger stick and has a prothrombin time of 30 seconds
• C. Febrile and has a WBC count of 14,000/mm3
• D. Trembling and has a glucose level of 50 mg/dL

Correct answer: D

Rationale: A glucose level of 50 mg/dL is indicative of hypoglycemia, which requires immediate intervention to prevent further complications. Hypoglycemia can lead to serious consequences such as altered mental status, seizures, and even coma if not promptly addressed. The other options do not present immediate life-threatening conditions that require urgent intervention. Shortness of breath with a hemoglobin of 8 grams may indicate anemia but does not require immediate intervention. Bleeding from a finger stick with a prothrombin time of 30 seconds may suggest clotting issues, which are important but not as immediately critical as hypoglycemia. Being febrile with an elevated WBC count could indicate infection, which is concerning but not as urgently critical as hypoglycemia.

4. A client is prescribed metformin for the management of type 2 diabetes. What is the primary action of this medication?

• A. Stimulates insulin secretion from the pancreas.
• B. Increases insulin sensitivity in various tissues.
• C. Decreases hepatic glucose production.
• D. Delays absorption of glucose from the intestines.

Correct answer: C

Rationale: The correct answer is C: Decreases hepatic glucose production. Metformin primarily works by reducing the production of glucose in the liver (hepatic glucose production) and by improving insulin sensitivity in various tissues. Choice A is incorrect as metformin does not stimulate insulin secretion from the pancreas. Choice B is incorrect as metformin increases insulin sensitivity in various tissues, not just muscle cells. Choice D is incorrect as metformin does not delay glucose absorption from the intestines.

5. A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which dietary instruction should the nurse provide?

• A. Increase intake of green leafy vegetables
• B. Avoid foods high in vitamin K
• C. Increase intake of foods rich in vitamin C
• D. Limit intake of dairy products

Correct answer: B

Rationale: The correct answer is B: 'Avoid foods high in vitamin K.' Vitamin K can decrease the effectiveness of warfarin, so it is essential for clients on warfarin therapy to avoid foods high in vitamin K. Green leafy vegetables are high in vitamin K, so choice A is incorrect. Choices C and D are unrelated to the dietary restrictions needed for clients taking warfarin and are therefore incorrect.

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