Nursing Elites

1. A nurse is caring for a client with a thiamine deficiency. Which assessment findings will the nurse expect?

• A. Tachycardia, muscle weakness, and lack of coordination
• B. Swollen lips, cracks in the corners of the mouth, and glossitis
• C. Neuropsychiatric symptoms of delusions and hallucinations
• D. Scaly rash on arms, dementia, and diarrhea

Correct answer: A

Rationale: Thiamine deficiency, also known as Vitamin B1 deficiency, can present with various symptoms. Tachycardia, muscle weakness, and lack of coordination are classic signs of thiamine deficiency due to its role in energy metabolism. Swollen lips, cracks in the corners of the mouth, and glossitis are more indicative of a deficiency in riboflavin (Vitamin B2). Neuropsychiatric symptoms of delusions and hallucinations are characteristic of niacin (Vitamin B3) deficiency. A scaly rash on the arms, dementia, and diarrhea are not typically associated with thiamine deficiency. Therefore, the correct assessment findings for a client with thiamine deficiency are tachycardia, muscle weakness, and lack of coordination.

2. A vegan patient might be at risk for deficiency in which of the following nutrients?

• A. Vitamin B12
• B. Vitamin C
• C. Carbohydrates
• D. Fiber

Correct answer: A

Rationale: The correct answer is Vitamin B12. Vitamin B12 is primarily found in animal products, so individuals following a vegan diet are at risk of deficiency as they do not consume these sources. Vitamin C, Carbohydrates, and Fiber are not specifically at risk for deficiency in vegan diets as they can be obtained from plant-based sources.

3. Which of the following is NOT a part of a process recording?

• A. Non-verbal narrative account
• B. Analysis and interpretation
• C. Audio-visual recording
• D. Verbal narrative account

Correct answer: C

Rationale: A process recording typically includes a non-verbal narrative account (Choice A), an analysis and interpretation (Choice B), and a verbal narrative account (Choice D). These components help in providing a comprehensive assessment of a patient's condition and ensuring that interventions are appropriately targeted for optimized outcomes. An audio-visual recording (Choice C), while it can be a part of some data collection processes, is not typically included in a process recording, making it the correct answer.

4. A client has bilateral eye patches in place following an injury. When the client's food tray arrives, which of the following interventions should the nurse take to promote independence in eating?

• A. Assign an assistive personnel to feed the client.
• B. Explain to the client that their tray is here and guide their hands to it.
• C. Describe to the client the location of the food on the tray.
• D. Ask the client if they would prefer a liquid diet.

Correct answer: C

Rationale: When a client has bilateral eye patches, promoting independence in eating is crucial to maintain dignity and autonomy. Describing the location of the food on the tray enables the client to locate and feed themselves. Assigning assistive personnel to feed the client (Choice A) takes away their independence. Merely informing the client that the tray is here and guiding their hands to it (Choice B) does not empower the client to eat independently. Asking if the client prefers a liquid diet (Choice D) is not directly addressing the client's ability to independently eat the current meal.

5. What instruction should the nurse include on weight gain during pregnancy?

• A. Failure to obtain the required weight gain during pregnancy will increase the risk of preterm birth.
• B. An obese client needs to 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 will need to eat for two when they are pregnant.

Correct answer: A

Rationale: Appropriate weight gain is crucial for reducing the risk of preterm birth.

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