Nursing Elites

1. When caring for a client diagnosed with delirium, what condition should the nurse prioritize investigating?

• A. Investigate medication history
• B. Investigate sensory deficits
• C. Investigate cognitive functioning
• D. Investigate for signs of infection

Correct answer: D

Rationale: The correct answer is to investigate for signs of infection when caring for a client diagnosed with delirium. Infections can frequently cause or worsen delirium. While investigating medication history, sensory deficits, and cognitive functioning may be important in the overall care of the client, when prioritizing, the nurse should first rule out or address potential infections due to their significant impact on delirium.

2. A client with peptic ulcer disease is being taught measures to prevent exacerbation of the condition. Which of the following instructions should the nurse include?

• A. Avoid consuming dairy products
• B. Limit alcohol consumption
• C. Use antacids frequently
• D. Drink coffee to improve digestion

Correct answer: B

Rationale: The correct answer is B: Limit alcohol consumption. Alcohol can irritate the stomach lining and worsen peptic ulcer disease. Avoiding dairy products is not necessary unless the client is lactose intolerant. Using antacids frequently may provide symptomatic relief but does not address the root cause of the condition. Drinking coffee can actually stimulate acid production and potentially aggravate peptic ulcers.

3. A nurse is teaching a client with diabetes about insulin administration. What is the most important point to emphasize?

• A. Check blood sugar once in the morning
• B. Administer insulin before meals as prescribed
• C. Administer insulin only when feeling unwell
• D. Monitor blood sugar only in the evening

Correct answer: B

Rationale: The most important point to emphasize when teaching a client with diabetes about insulin administration is to administer insulin before meals as prescribed. This is crucial for maintaining proper blood sugar control throughout the day. Choice A is incorrect because blood sugar levels need to be monitored multiple times a day, not just once in the morning. Choice C is incorrect because insulin should be administered according to the prescribed schedule, not only when feeling unwell. Choice D is incorrect because blood sugar monitoring should be done at various times during the day, not just in the evening.

4. A healthcare professional is planning care for a client who has a prescription for mechanical restraints. Which of the following interventions should the healthcare professional include in the plan?

• A. Document the client's status every 60 minutes.
• B. Provide a staff member to stay with the client continuously.
• C. Measure vital signs every 4 hours.
• D. Obtain a prescription for the restraints every 8 hours.

Correct answer: B

Rationale: When a client has a prescription for mechanical restraints, it is essential to provide continuous monitoring for their safety and to observe any behavioral changes. Having a staff member stay with the client continuously allows for immediate intervention if needed. Documenting the client's status every 60 minutes (Choice A) may not provide real-time monitoring, which is crucial in this situation. While measuring vital signs every 4 hours (Choice C) is important, continuous observation takes precedence in this scenario. Obtaining a prescription for the restraints every 8 hours (Choice D) is not a necessary intervention once the initial prescription is in place.

5. A client who has a new prosthesis for an above-the-knee amputation of the right leg needs teaching on its use. Which of the following instructions should the nurse include?

• A. Wear the prosthesis for 2 hours at a time
• B. Remove the prosthesis every other day
• C. Apply the prosthesis immediately upon waking each day
• D. Elevate the stump for 24 hours after applying the prosthesis

Correct answer: C

Rationale: The correct instruction is to apply the prosthesis immediately upon waking each day. This helps the client adjust to and maintain mobility. Choice A is incorrect because wearing the prosthesis for only 2 hours at a time may not be sufficient for proper adjustment. Choice B is incorrect as removing the prosthesis every other day is not a standard practice and may hinder the client's mobility. Choice D is incorrect because elevating the stump for 24 hours after applying the prosthesis is unnecessary and not a recommended practice.

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