Nursing Elites

1. A community health nurse is conducting a class on what to expect during pregnancy. What instruction should the nurse include on weight gain?

• A. Failure to obtain the required weight gain during pregnancy will increase the risk of preterm birth.
• B. An obese client should not gain as much weight as a client with a normal body mass index.
• C. A client with a normal body mass index should plan on gaining 50 pounds.
• D. Clients do not need to eat for two when they are pregnant.

Correct answer: A

Rationale: Adequate weight gain during pregnancy is essential as failure to obtain the required weight gain can increase the risk of preterm birth. Choice B is incorrect because it is important for obese clients to gain an appropriate amount of weight during pregnancy, not the same as those with a normal body mass index. Choice C is incorrect as gaining 50 pounds for a client with a normal body mass index is excessive. Choice D is incorrect as the common saying 'eating for two' during pregnancy is a misconception; pregnant individuals do not need to double their caloric intake.

2. A nurse is completing an admission assessment on an adolescent client who is vegan. Which breakfast item should the nurse recommend as a protein combination with their diet restriction?

• A. Bagel with cream cheese
• B. Wheat toast with jelly
• C. Oatmeal pancakes with peanut butter
• D. Eggs with tofu bacon

Correct answer: C

Rationale: The correct answer is C: Oatmeal pancakes with peanut butter. For a vegan client, it is important to recommend plant-based protein sources. Oatmeal pancakes with peanut butter offer a good protein combination that aligns with their dietary restriction. Choices A, B, and D are not suitable as they all contain animal-derived products, which are not suitable for a vegan diet.

3. During the first 24 hours after the thermal injury, you should assess Sergio for:

• A. hypokalemia and hypernatremia
• B. hypokalemia and hyponatremia
• C. hyperkalemia and hyponatremia
• D. hyperkalemia and hypernatremia

Correct answer: D

Rationale: During the initial phase after a thermal injury, the major concern is the release of potassium due to cell damage, leading to hyperkalemia. Hypernatremia is not typically a primary concern in the immediate post-injury phase. Hyponatremia is less likely to occur initially after a burn injury. Therefore, the correct assessment for Sergio during the first 24 hours after the thermal injury would be hyperkalemia and hypernatremia.

4. A nurse is providing preventative information to a group of parents with toddlers about choking. Which food item should the nurse recommend for this age group?

• A. Banana slices
• B. Popcorn
• C. Hot dogs
• D. Carrot sticks

Correct answer: A

Rationale: Banana slices are the most suitable food option for toddlers to prevent choking. Toddlers are at a higher risk of choking due to their small airways and developing chewing abilities. Banana slices are soft, easy to chew, and less likely to cause choking compared to other options. Popcorn and hot dogs are common choking hazards for young children due to their shape and texture. While carrot sticks may be a healthy choice, they can also pose a choking risk due to their hardness and shape. Therefore, recommending banana slices to parents of toddlers is the safest choice to prevent choking incidents, making choice 'A' the correct answer. Choices 'B', 'C', and 'D' are incorrect because they can potentially cause choking in toddlers.

5. A client has a small-bore jejunostomy and is receiving a continuous tube feeding with a high-viscosity formula. Which of the following actions should the nurse take to prevent the tubing from clogging?

• A. Replace the bag and tubing every 24 hours
• B. Flush the tubing with 10 mL water every 6 hours
• C. Administer the feeding by gravity drip
• D. Heat the formula prior to infusion

Correct answer: B

Rationale: To prevent clogging when using high-viscosity formulas in a small-bore jejunostomy, the nurse should flush the tubing with 10 mL of water every 6 hours. This action helps maintain tube patency and prevent blockages. Replacing the bag and tubing every 24 hours (Choice A) is unnecessary and does not specifically address preventing clogging. Administering the feeding by gravity drip (Choice C) or heating the formula prior to infusion (Choice D) are not effective interventions for preventing tubing clogging.

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