Nursing Elites

1. A 67-year-old client is admitted with substernal chest pain with radiation to the jaw. His admitting diagnosis is Acute Myocardial Infarction (MI). The priority nursing diagnosis for this client during the immediate 24 hours is

• A. Constipation related to immobility
• B. High risk for infection
• C. Impaired gas exchange
• D. Fluid volume deficit

Correct answer: C

Rationale: The correct answer is C: Impaired gas exchange. In a client with an acute myocardial infarction, impaired gas exchange is a priority nursing diagnosis due to compromised heart function, which affects oxygenated blood circulation. Close monitoring and interventions are crucial to ensure adequate oxygenation. Choices A, B, and D are incorrect: A) Constipation related to immobility is not the priority in this acute situation; B) High risk for infection is not the immediate concern related to the client's primary diagnosis; D) Fluid volume deficit, while important, is not the priority compared to addressing impaired gas exchange in acute MI.

2. Environmental sanitation is the primary problem in community Y. As a stranger to the health unit, one of the major strategies in your plan is the improvement of the environmental health conditions of the community. To indicate this, which of the following would you do?

• A. meet with youth officials and parents' group leaders
• B. meet with religious and educational leaders
• C. request mayors to create a task force to help implement your project
• D. inform local announcers to disseminate the what and why of your project

Correct answer: C

Rationale: In this scenario, requesting mayors to create a task force is the most effective strategy to improve environmental health conditions in the community. Engaging with local government officials ensures the allocation of resources, coordination of efforts, and the implementation of sustainable solutions. While meeting with youth officials, parents' group leaders, religious and educational leaders are important, involving mayors in creating a task force will lead to broader community involvement and support. Informing local announcers about the project, although helpful for awareness, is not as impactful as engaging with local authorities for tangible change.

3. Which of the following is an example of a modifiable risk factor for chronic diseases?

• A. Age
• B. Gender
• C. Genetic predisposition
• D. Physical inactivity

Correct answer: D

Rationale: Physical inactivity is a modifiable risk factor for chronic diseases because individuals have control over their level of physical activity. By increasing physical activity, the risk of chronic diseases can be reduced. Choices A, B, and C are not modifiable risk factors: Age is a non-modifiable factor, gender is a biological characteristic, and genetic predisposition is inherent and cannot be altered.

4. A client is scheduled to have a blood test for cholesterol and triglycerides the next day. The nurse would tell the client

• A. ''Be sure to eat a fat-free diet until the test.''
• B. ''Do not eat or drink anything but water for 12 hours before the blood test.''
• C. ''Have the blood drawn within 2 hours of eating breakfast.''
• D. ''Stay at the laboratory so 2 blood samples can be drawn an hour apart.''

Correct answer: B

Rationale: Fasting for at least 12 hours is necessary before a cholesterol and triglyceride test to ensure accurate results by avoiding fluctuations that can occur after eating. Choice A is incorrect because a fat-free diet is not required; fasting is. Choice C is incorrect as it suggests having the test right after eating, which can affect the results. Choice D is incorrect as there is no need to stay at the laboratory for 2 blood samples unless specifically instructed by a healthcare provider.

5. In providing comprehensive family health care, the nurse utilizes four (4) basic processes. These are listed in the order in which they are carried out as follows:

• A. assessment, planning, intervention, and evaluation
• B. assessment, intervention, planning, and evaluation
• C. planning, assessment, intervention, and evaluation
• D. planning, intervention, evaluation, and assessment

Correct answer: A

Rationale: The correct order for the basic processes in providing comprehensive family health care is assessment, planning, intervention, and evaluation. Assessment is the first step to gather information, followed by planning to set goals and strategies, then intervention to implement the plan, and finally evaluation to assess the outcomes. Choice A is correct as it follows this logical sequence. Choices B, C, and D are incorrect because they do not follow the correct order of these essential processes in nursing care.

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