Nursing Elites

1. What action should a healthcare provider take if a patient reports cramping during enema administration?

• A. Lower the height of the solution container
• B. Increase the flow of the enema solution
• C. Stop the procedure and remove the tubing
• D. Continue the enema at a slower rate

Correct answer: A

Rationale: When a patient reports cramping during enema administration, the best action is to lower the height of the enema solution container. This adjustment helps relieve abdominal cramping by slowing down the flow of the enema, making it more comfortable for the patient. Increasing the flow of the solution (choice B) would exacerbate the cramping. Stopping the procedure and removing the tubing (choice C) may be necessary in some cases but should not be the first response to cramping. Continuing the enema at a slower rate (choice D) might not be as effective as lowering the height of the solution container in addressing the cramping.

2. What is the priority intervention for a patient with possible acute coronary syndrome?

• A. Administer nitroglycerin
• B. Get IV access
• C. Auscultate heart sounds
• D. Administer aspirin

Correct answer: A

Rationale: The correct answer is to administer nitroglycerin. Nitroglycerin is the priority intervention for a patient with possible acute coronary syndrome as it helps dilate blood vessels, reduce chest pain, and improve blood flow to the heart. This intervention is crucial in managing acute coronary syndrome and should be given promptly. Getting IV access may be necessary, but administering nitroglycerin takes precedence to alleviate symptoms and prevent further heart damage. Auscultating heart sounds and administering aspirin are important aspects of the assessment and treatment plan, but they are not the priority interventions in the acute phase of suspected acute coronary syndrome.

3. What dietary recommendations are given to a patient with pre-dialysis end-stage kidney disease?

• A. Reduce phosphorus intake to 700 mg/day
• B. Increase sodium intake
• C. Restrict protein intake to 0.55-0.60 g/kg/day
• D. Increase protein intake

Correct answer: A

Rationale: The correct recommendation for a patient with pre-dialysis end-stage kidney disease is to reduce phosphorus intake to 700 mg/day. Excessive phosphorus intake can be harmful to individuals with kidney disease as their kidneys may not be able to excrete it efficiently. Choice B is incorrect because increasing sodium intake is generally not recommended for patients with kidney disease, as it can contribute to fluid retention and high blood pressure. Choice C is incorrect as protein restriction is commonly advised for individuals with advanced kidney disease to reduce the workload on the kidneys. Choice D is also incorrect as increasing protein intake can further burden the kidneys.

4. A patient with chronic kidney disease may require dietary restrictions. Which of the following diets should the healthcare provider prescribe?

• A. Low sodium diet
• B. Potassium restricted diet
• C. High phosphorus diet
• D. High protein diet

Correct answer: B

Rationale: Patients with chronic kidney disease often require a potassium-restricted diet to help manage their electrolyte levels. Excessive potassium intake can be harmful to individuals with compromised kidney function. While monitoring sodium intake is also important for these patients, a low sodium diet is not specifically indicated in the question. High phosphorus diet and high protein diet are not recommended for individuals with chronic kidney disease as they can further stress the kidneys and worsen the condition.

5. A client has a right-sided pneumothorax, and a chest tube is inserted. Which finding indicates that the chest drainage system is functioning correctly?

• A. Gentle bubbling in the suction chamber
• B. Crepitus around the insertion site
• C. Constant bubbling in the water seal chamber
• D. Absence of breath sounds on the right side

Correct answer: A

Rationale: In a chest drainage system, gentle bubbling in the suction chamber indicates proper functioning, showing that the system is connected and working effectively to remove air or fluid from the pleural space. Crepitus around the insertion site (Choice B) suggests subcutaneous emphysema, not chest tube functionality. Constant bubbling in the water seal chamber (Choice C) indicates an air leak. Absence of breath sounds on the right side (Choice D) is indicative of the pneumothorax, not the chest tube function.

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