Nursing Elites

1. An elderly male client who suffered a cerebral vascular accident is receiving tube feedings via a gastrostomy tube. The LPN knows that the best position for this client during administration of the feedings is

• A. prone.
• B. Fowler's.
• C. Sims'.
• D. supine.

Correct answer: B

Rationale: Fowler's position is the optimal position for a client receiving tube feedings via a gastrostomy tube because it reduces the risk of aspiration. In Fowler's position, the client is sitting up at a 45- to 60-degree angle, which helps prevent the formula from flowing back into the esophagus and causing aspiration pneumonia. Choice A, prone position (lying face down), would not be suitable for administering tube feedings as it increases the risk of aspiration. Sims' position (lying on the left side with the right knee flexed) and supine position (lying flat on the back) are also not ideal for administering tube feedings as they do not provide the same level of protection against aspiration as Fowler's position does.

2. A nurse at a health department is planning strategies related to heart disease. Which of the following activities should the nurse include as part of primary prevention?

• A. Providing cholesterol screening
• B. Teaching about a healthy diet
• C. Providing information about antihypertensive medications
• D. Developing a list of cardiac rehabilitation programs

Correct answer: B

Rationale: Teaching about a healthy diet is considered a primary prevention activity. Primary prevention aims to prevent the onset of a disease or health problem. Educating individuals on healthy lifestyle choices, such as diet modification, falls under primary prevention. Providing cholesterol screening (choice A) is a secondary prevention measure aimed at early detection. Offering information about antihypertensive medications (choice C) falls under secondary prevention, focusing on controlling risk factors. Developing a list of cardiac rehabilitation programs (choice D) is part of tertiary prevention, focusing on rehabilitation and improving outcomes post-disease onset.

3. When should discharge planning be initiated for a client experiencing an exacerbation of heart failure?

• A. During the admission process.
• B. After the client stabilizes.
• C. Only after the client requests it.
• D. At the time of discharge.

Correct answer: A

Rationale: Discharge planning should begin during the admission process for a client experiencing an exacerbation of heart failure. Initiating discharge planning early ensures timely and effective care transitions, which are crucial for managing the client's condition and preventing readmissions. Waiting until after the client stabilizes (choice B) could lead to delays in arranging necessary follow-up care and support services. Similarly, waiting for the client to request discharge planning (choice C) may result in missed opportunities for comprehensive care coordination. Planning at the time of discharge (choice D) is too late, as early intervention is key to promoting the client's well-being and recovery in the long term.

4. A client is 24 hours postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for “real food.” The nurse tells the client, “I will call the surgeon and ask for a change in diet.” The surgeon hears the nurse’s report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking?

• A. Basic
• B. Commitment
• C. Complex
• D. Integrity

Correct answer: C

Rationale: The nurse demonstrated complex critical thinking by assessing the client's condition, evaluating the need for a change, and making a recommendation to the surgeon. In this scenario, the nurse went beyond simply following instructions or making routine decisions (basic critical thinking). There was a depth of analysis and decision-making involved, showing a higher level of critical thinking than basic or commitment levels. Integrity is about adherence to ethical principles and honesty, not directly related to the critical thinking process.

5. A community health nurse is caring for a group of families. The nurse should identify which of the following families is experiencing a maturational loss?

• A. A family whose only child recently died due to cancer.
• B. A family whose head of household lost her job.
• C. A family whose house was destroyed in a fire.
• D. A family whose oldest child is moving away for college.

Correct answer: D

Rationale: The correct answer is D because maturational loss is related to developmental changes, such as children leaving for college. This type of loss is tied to the normal life transitions of individuals and can lead to feelings of grief and adjustment. Choices A, B, and C represent different types of losses. Choice A involves a traumatic loss of a child due to illness, choice B involves a financial loss impacting the head of household's job, and choice C involves a material loss due to a fire incident. While these losses are significant, they do not specifically relate to maturational loss, which is associated with expected life stage transitions.

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