Nursing Elites

1. A client at high risk for iron deficiency anemia should increase the consumption of which of the following foods?

• A. Yogurt
• B. Apples
• C. Raisins
• D. Cheddar cheese

Correct answer: C

Rationale: The correct answer is C: Raisins. Raisins are a good source of iron, making them beneficial for a client at high risk for iron deficiency anemia. Yogurt (Choice A), apples (Choice B), and cheddar cheese (Choice D) are not significant sources of iron. Other iron-rich foods include dried fruits, red meat, and green leafy vegetables.

2. What adverse effect might occur in a patient receiving radiation after a mastectomy?

• A. Seizures
• B. JVD and fatigue
• C. SOB and JVD
• D. S3 heart sound

Correct answer: D

Rationale: The correct adverse effect that might occur in a patient receiving radiation after a mastectomy is the development of an S3 heart sound. This can result from decreased pumping ability following mastectomy and radiation treatment. Choice A, seizures, is incorrect as seizures are not a common adverse effect of radiation after a mastectomy. Choice B, JVD and fatigue, is incorrect as while fatigue can be a common side effect, JVD (Jugular Venous Distention) is not typically associated with radiation after a mastectomy. Choice C, SOB (Shortness of Breath) and JVD, is incorrect as while shortness of breath can occur, JVD is not a typical adverse effect of radiation post-mastectomy.

3. What are the expected manifestations in a patient experiencing a thrombotic stroke?

• A. Sudden numbness or loss of function on one side of the body
• B. Sudden loss of consciousness and seizure
• C. Gradual onset of difficulty speaking
• D. Loss of sensation in the affected limb

Correct answer: A

Rationale: The correct manifestation in a patient experiencing a thrombotic stroke is sudden numbness or loss of function on one side of the body. This is due to the blockage of a blood vessel by a clot, leading to a lack of blood flow to a specific part of the brain. Choices B, C, and D are incorrect. Sudden loss of consciousness and seizure are more commonly associated with hemorrhagic strokes. Gradual onset of difficulty speaking is often seen in ischemic strokes affecting language areas, not specifically in thrombotic strokes. Loss of sensation in the affected limb is more indicative of sensory nerve damage rather than the motor deficits seen in thrombotic strokes.

4. What are the early signs of increased intracranial pressure (IICP)?

• A. Restlessness, irritability, and confusion
• B. Sudden onset of seizures
• C. Decreased heart rate and pupillary response
• D. Loss of consciousness

Correct answer: A

Rationale: The correct answer is A: Restlessness, irritability, and confusion are early signs of increased intracranial pressure (IICP). These signs indicate that the brain is starting to experience pressure, often due to conditions such as trauma, tumors, or hemorrhage. Sudden onset of seizures (choice B) is not typically an early sign of IICP but can occur later as the pressure increases. Decreased heart rate and pupillary response (choice C) are more indicative of late-stage IICP as the brainstem becomes compromised. Loss of consciousness (choice D) is a late sign of IICP when the pressure has significantly increased and is causing significant brain dysfunction.

5. A nurse is assessing a client who has a sodium level of 122 mEq/L. Which of the following findings should the nurse expect?

• A. Decreased deep tendon reflexes
• B. Positive Chvostek's sign
• C. Hyperactive bowel sounds
• D. Dry mucous membranes

Correct answer: A

Rationale: Corrected deep tendon reflexes occur with hyponatremia. Other manifestations of hyponatremia include headache, confusion, lethargy, fatigue, seizures, and muscle weakness. Positive Chvostek's sign is associated with hypocalcemia, hyperactive bowel sounds are not typically related to hyponatremia, and dry mucous membranes are more commonly seen with dehydration.

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