Nursing Elites

1. 24 hours after the creation of a colostomy, what should Nurse Violy identify as the normal appearance of the stoma?

• A. Pink, moist, and slightly protruding from the abdomen
• B. Gray, moist, and slightly protruding from the abdomen
• C. Pink, dry, and slightly protruding from the abdomen
• D. Red, moist, and slightly protruding from the abdomen

Correct answer: A

Rationale: Following colostomy surgery, a healthy stoma should appear pink, moist, and slightly protruding from the abdomen, which is why option 'A' is the correct answer. A gray stoma (choice 'B') could indicate poor blood supply or necrosis, which is a serious complication. A dry stoma (choice 'C') is also not normal as it should be moist; a dry stoma may suggest dehydration or other complications. While a stoma can appear red (choice 'D'), this is not typically the normal color; it should usually be pink. Therefore, it's important for healthcare professionals to correctly identify the normal and abnormal appearances of a stoma to ensure proper patient care.

2. How is the equalization of solute concentration of intracellular fluids (ICFs) and extracellular fluids (ECFs accomplished?

• A. Semipermeable membranes.
• B. Hydration.
• C. Osmotic pressure.
• D. Perspiration.

Correct answer: C

Rationale: The correct answer is C, osmotic pressure. Osmotic pressure within the body equalizes the solute concentration of ICFs and ECFs by shifting small amounts of water in the direction of higher concentration solute. Semipermeable membranes separate one fluid compartment from another and do not directly equalize solute concentrations. Hydration and perspiration are important elements of fluid balance but do not directly achieve the equalization of solute concentrations between ICFs and ECFs, which is primarily regulated by osmotic pressure.

3. In a patient with liver cirrhosis, weight gain due to fluid retention can mask the symptoms of what condition?

• A. Liver failure
• B. Gallbladder disease
• C. Heart failure
• D. Protein-Energy Malnutrition (PEM)

Correct answer: D

Rationale: In a patient with liver cirrhosis, weight gain due to fluid retention can mask Protein-Energy Malnutrition (PEM) symptoms. This can lead to an increase in weight, making it challenging to identify weight loss or muscle wasting associated with PEM. Therefore, option D is correct. Options A, B, and C are incorrect because fluid retention and weight gain related to liver cirrhosis do not necessarily hide the symptoms of liver failure, gallbladder disease, or heart failure.

4. She instructed the interviewees not to tell the interviewees that the data gathered are for her own research project for publication. This teacher has violated the student’s right to:

• A. Not be harmed
• B. Disclosure
• C. Privacy
• D. Self-determination

Correct answer: D

Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.

5. The rationales for using a prostaglandin gel for a client prior to the induction of labor is to:

• A. Soften and efface the cervix
• B. Numb cervical pain receptors
• C. Prevent cervical lacerations
• D. Stimulate uterine contractions

Correct answer: C

Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.

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