Which of the following foods should a client with hypercholesterolemia decrease in their diet?

Correct Answer: B

Rationale: The correct answer is B: Hamburgers. Clients with hypercholesterolemia should decrease their intake of saturated fats and cholesterol. Hamburgers are typically high in saturated fats and cholesterol due to the ground beef patty and cheese. Broiled catfish (A) is a lean protein source and can be a healthier option. Wheat bread (C) is a good source of fiber and can help lower cholesterol levels. Fresh apples (D) are a healthy choice low in saturated fats and cholesterol. Therefore, hamburgers should be decreased in the diet to manage hypercholesterolemia effectively.

Correct Answer: A

Rationale: The correct first action for a nurse when caring for a client with acute shortness of breath is to administer oxygen (Choice A). Oxygen is essential to support the client's respiratory function and improve oxygenation. Administering corticosteroids (Choice B) may be considered later for certain underlying conditions, but oxygen takes precedence. Administering pain relief (Choice C) is not the priority in this situation. Placing the client in a supine position (Choice D) can potentially worsen respiratory distress in some cases, making it an incorrect choice.

Correct Answer: D

Rationale: The correct answer is D because polio, pertussis, and measles are highly infectious diseases that can have severe consequences if not prevented through vaccination. Polio can cause paralysis, pertussis can be fatal in infants, and measles can lead to complications like pneumonia and encephalitis. Emphasizing these vaccines can significantly reduce the risk of outbreaks and protect public health. Choice A is incorrect because HPV and genital herpes are sexually transmitted infections, and although important, they are not typically prevented through vaccines like polio, pertussis, and measles. Choice B is incorrect because pneumonia, HIV, and mumps, while serious diseases, do not have vaccines that are as universally recommended for prevention as polio, pertussis, and measles. Choice C is incorrect because syphilis and gonorrhea are sexually transmitted infections, and pneumonia is not typically prevented through vaccination as effectively as polio, pertussis, and measles.

Correct Answer: B

Rationale: The correct answer is B: Eggs. Eggs are considered a complete protein because they contain all nine essential amino acids required by the body. These amino acids are necessary for various bodily functions, such as muscle growth and repair. Corn (A), peanuts (C), and sunflower seeds (D) are incomplete proteins as they lack one or more essential amino acids. Therefore, eggs are the best choice for a complete protein source compared to the other options provided.

Correct Answer: A

Rationale: The correct answer is A: Place the client in a safe environment. This is the primary intervention for a client with a history of falls to prevent further injury. By ensuring the environment is safe, the risk of falls and subsequent injuries is minimized. Choice B, assessing the client's functional status, is important but not the primary intervention. Choice C, encouraging the client to rest, may not address the underlying issue of fall risk. Choice D, encouraging the client to ambulate, may increase the risk of falls for someone with a history of falls. It is crucial to prioritize safety by modifying the environment to prevent falls.

Correct Answer: D

Rationale: The correct answer is D. The nursing process consists of Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation. Assessment involves gathering data about the patient's health status. Diagnosis is the identification of the patient's health problems. Outcome Identification sets goals for resolving these problems. Planning involves developing a care plan. Implementation is the execution of the care plan. Evaluation assesses the effectiveness of the care provided. Choices A, B, and C are incorrect: A: Treatment and client outcome are not individual phases in the nursing process. B: Admission and discharge planning are not standalone phases in the nursing process. C: Expected outcome is not a phase, and assessment is missing from the sequence.

Correct Answer: A

Rationale: The correct answer is A: Assess the patient's level of understanding about diabetes management. This is the most important nursing action because it enables the nurse to tailor education and interventions to the patient's specific needs. By assessing the patient's understanding, the nurse can address any misconceptions, provide appropriate education, and promote self-management. Checking blood sugar levels every hour (B) is excessive and not necessary unless indicated. Instructing the patient to avoid all sugar-containing foods (C) is overly restrictive and not evidence-based. Ensuring the patient is compliant with their insulin regimen (D) is important but assessing understanding is crucial for effective diabetes management.

Correct Answer: B

Rationale: The correct answer is B because encouraging early ambulation is a priority post-operative intervention for a patient following a hip replacement. Early ambulation helps prevent complications such as blood clots, muscle weakness, and pneumonia. It also promotes circulation and aids in the patient's recovery. Administering pain medications (A) is important but not the top priority. Monitoring for signs of infection (C) is crucial, but ambulation takes precedence. Providing wound care (D) is essential but can be done after ensuring the patient's mobility.

Correct Answer: A

Rationale: The correct answer is A: Administer IV fluids. Dehydration and hypotension indicate fluid loss, which can lead to organ damage and shock. Administering IV fluids helps restore blood volume and improve blood pressure. Monitoring blood pressure (B) is important but addressing the underlying issue of fluid loss is crucial. Administering antihypertensive medications (C) would further lower blood pressure, worsening hypotension. Administering diuretics (D) would exacerbate fluid loss, worsening dehydration and hypotension.