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The nurse is assessing a patient's understanding of the DASH (Dietary Approaches to Stop Hypertension) diet. Which patient behavior suggests adherence to this diet?
- A. The patient exclusively consumes lactose-free dairy products.
- B. The patient meticulously cleans and peels all fresh fruits and vegetables.
- C. The patient enjoys fat-free yogurt as an occasional snack.
- D. The patient has eliminated grains from their diet.
Correct Answer: C
Rationale: Consuming fat-free yogurt aligns with the DASH diet's emphasis on low-fat dairy, supporting blood pressure control.
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The healthcare provider prescribes diagnostic tests for a patient whose chest x-ray indicates pneumonia. Which diagnostic test should the nurse prepare the patient for?
- A. Computerized tomography (CT) of the chest.
- B. Arterial blood gases (ABG).
- C. Sputum culture and sensitivity.
- D. Blood cultures.
Correct Answer: C
Rationale: A sputum culture and sensitivity test identifies the causative organism of pneumonia, guiding appropriate antibiotic therapy.
A patient with a full-thickness burn covering 40% of their body is exhibiting purulent drainage at the wound site. Before reporting this finding to the healthcare provider, which of the patient's laboratory values should the nurse review?
- A. Blood pH level
- B. Hematocrit
- C. White blood cell (WBC) count
- D. Platelet count
Correct Answer: C
Rationale: WBC count indicates infection, relevant to purulent drainage in a burn wound.
After a transurethral resection of the prostate (TURP), a patient is discharged from the hospital with an indwelling urinary catheter. What is the most important instruction for the nurse to include in the discharge teaching plan?
- A. Eliminate all spicy foods from your diet
- B. Drink 3 liters of water each day
- C. Clamp the catheter when taking a shower
- D. Avoid driving a car for 2 weeks
Correct Answer: B
Rationale: Adequate hydration (3 liters daily) prevents urinary tract infections and supports recovery after TURP.
While assessing a patient with degenerative joint disease, the nurse notices Heberden's nodes, and large prominences on the patient's fingers that are reddened and painful. What should the nurse do?
- A. Discuss strategies for managing chronic pain with the patient.
- B. Check the patient's radial pulses and capillary refill time.
- C. Immediately notify the healthcare provider of the finding.
- D. Review the patient's dietary intake of high-protein foods.
Correct Answer: A
Rationale: Discussing chronic pain management strategies addresses the discomfort associated with Heberden's nodes, a common osteoarthritis feature.
The nurse assesses a client with cirrhosis and finds 4+ pitting edema of the feet and legs, and massive ascites. Which mechanism contributes to edema.Concurrent and ascites in clients with cirrhosis?
- A. Decreased renin-angiotensin response related to an increase in renal blood flow.
- B. Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
- C. Hyperaldosteronism causing an increased sodium reabsorption in renal tubules.
- D. Decreased portacaval pressure with greater collateral circulation.
Correct Answer: B
Rationale: Hypoalbuminemia reduces oncotic pressure, causing fluid to leak into tissues and abdomen, leading to edema and ascites.