Nursing Elites

1. A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client’s fluid status?

• A. Measuring and recording fluid intake and output
• B. Weighing the client daily at the same time each day
• C. Assessing the client’s vital signs every 4 hours
• D. Checking the client’s lungs for crackles during every shift

Correct answer: B

Rationale: Weighing the client daily at the same time each day is the most accurate method for monitoring fluid balance. Changes in body weight can reflect fluid retention or loss. Measuring and recording fluid intake and output (Choice A) is important but may not provide immediate changes in fluid status. Assessing vital signs (Choice C) can offer some information but may not be as specific to fluid status as daily weighing. Checking the client's lungs for crackles (Choice D) is more related to assessing respiratory status rather than direct fluid monitoring.

2. Whenever possible, patients evacuated from the theater of operations who are expected to return within 60 days are admitted to which of the following?

• A. Civilian hospitals participating in the National Disaster Medical System
• B. DOD tri-service hospitals
• C. Department of Veterans Affairs hospitals
• D. Temporary field hospitals

Correct answer: B

Rationale: Patients evacuated from the theater of operations and expected to return within 60 days are admitted to DOD tri-service hospitals. These hospitals are well-equipped to handle military personnel and are strategically placed for operational efficiency. Choice A, civilian hospitals participating in the National Disaster Medical System, may not have the specialized care and resources required for military personnel. Choice C, Department of Veterans Affairs hospitals, cater to veterans rather than active-duty personnel in theater. Choice D, temporary field hospitals, might not provide the comprehensive care and resources needed for an extended period of treatment.

3. Which of the following is inappropriate in collecting midstream clean-catch urine specimen for urine analysis?

• A. Collect early in the morning, first voided specimen
• B. Do perineal care before specimen collection
• C. Collect 5 to 10 ml of urine
• D. Discard the first flow of urine

Correct answer: C

Rationale: The inappropriate action in collecting a midstream clean-catch urine specimen for urine analysis is to collect only 5 to 10 ml of urine. Adequate urine volume of 30 to 60 ml is required for accurate testing. Collecting a small amount like 5 to 10 ml may lead to inaccurate results due to insufficient sample size. It is crucial to follow proper collection techniques, such as discarding the first flow of urine, performing perineal care, and collecting an adequate volume, to ensure reliable test results.

4. What is the COMMZ level hospital whose principal mission is to treat and rehabilitate those patients who can return to duty within the stated theater evacuation policy?

• A. FSB
• B. CSH
• C. GH
• D. FH

Correct answer: C

Rationale: The correct answer is C, GH (General Hospital), as it is the COMMZ level hospital that focuses on treating and rehabilitating patients who can return to duty within the theater evacuation policy. FSB (Forward Surgical Hospital) primarily provides surgical care close to the front lines. CSH (Combat Support Hospital) offers more comprehensive surgical and medical care than FSB but does not focus on rehabilitation like GH. FH (Field Hospital) provides initial medical care and stabilization before patients are evacuated to higher-level facilities.

5. When does short-bowel syndrome usually occur?

• A. The longitudinal muscles of the intestine contract
• B. More than 50% of the small intestine is surgically removed
• C. More than 50% of the large intestine is surgically removed
• D. Transit time is decreased due to infection or drugs

Correct answer: B

Rationale: Short-bowel syndrome typically occurs when more than 50% of the small intestine is surgically removed. This condition leads to malabsorption issues due to the reduced length of the intestine for absorption. Choices A, C, and D are incorrect because short-bowel syndrome specifically relates to the insufficient length of the small intestine, not the contraction of longitudinal muscles, surgical removal of the large intestine, or decreased transit time due to infection or drugs.

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