Nursing Elites

1. Angie is a disoriented client who frequently falls from the bed. As her nurse, which of the following is the best nursing intervention to prevent future falls?

• A. Tell Angie not to get up from bed unassisted
• B. Put the call bell within her reach
• C. Put bedside commode at the bedside to prevent Angie from getting up
• D. Put the bed in the lowest position ever

Correct answer: B

Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.

2. A nurse is planning care for a toddler who has burns over 50% total body surface area. Which of the following actions should the nurse include in the plan of care?

• A. Administer enteral feedings
• B. Limit intake of vitamin C
• C. Limit dietary protein
• D. Administer insulin prior to meals

Correct answer: A

Rationale: Administering enteral feedings is crucial for ensuring adequate nutrition and supporting healing in toddlers with extensive burns. Burns over 50% total body surface area can lead to increased metabolic demands, making it essential to provide nutrition through enteral feedings to meet the child's needs for healing and recovery. Limiting intake of vitamin C or dietary protein would be detrimental in this scenario as the child requires increased amounts of nutrients to support healing. Administering insulin prior to meals is not indicated in this case as the priority is to provide adequate nutrition to promote healing.

3. Carmen discovers that the DASH diet contains more fiber and ____ compared to that of the typical American diet.

• A. vitamin C
• B. iron
• C. potassium
• D. sodium

Correct answer: C

Rationale: The correct answer is C: 'potassium.' The DASH diet is rich in potassium, which helps lower blood pressure, making it more effective than the typical American diet, which is often low in this essential mineral. Choice A, 'vitamin C,' is incorrect as the comparison is about fiber and another nutrient, not vitamin C. Choice B, 'iron,' is incorrect as the discussion is about fiber and a mineral that helps lower blood pressure, not iron. Choice D, 'sodium,' is incorrect as the DASH diet actually focuses on reducing sodium intake for better blood pressure control, so it wouldn't be a nutrient found in higher amounts compared to the typical American diet.

4. 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.

5. Why is bleeding in the leg of a pregnant woman considered as an emergency?

• A. Blood volume is greater in pregnant woman; therefore, blood loss is increased
• B. There is an increase blood pressure during pregnancy increasing the likelihood of hemorrhage
• C. Pregnant woman are anemic, all forms of blood loss should be considered as an emergency especially if it is in the
• D. The pressure of the gravid uterus will exert additional force thus, increasing the blood loss in the lower extremities

Correct answer: B

Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.

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