Nursing Elites

1. Determining nursing care priorities is a part of which of the following steps in determining and fulfilling the nursing care needs of the patient?

• A. Evaluation
• B. Planning
• C. Implementation
• D. Assessment

Correct answer: B

Rationale: Corrected Rationale: Planning in nursing involves setting priorities based on the patient's needs, resources, and desired outcomes. It includes organizing and coordinating care activities to achieve the identified goals. Therefore, determining nursing care priorities is a key aspect of the planning phase.\n Incorrect Rationales:\n- Evaluation (Choice A) comes after implementing the care plan to assess the effectiveness of interventions and make necessary adjustments.\n- Implementation (Choice C) is the phase where the care plan is put into action, involving carrying out the nursing interventions designed during the planning phase.\n- Assessment (Choice D) is the initial step in the nursing process where data about the patient's health status is collected and analyzed to identify needs and formulate a care plan. It precedes planning and determining care priorities.

2. The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. The nurse explains to the client that this is administered to:

• A. Provide nutrients
• B. Increase protein stores
• C. Elevate the circulating blood volume
• D. Divert blood flow away from the liver temporarily

Correct answer: C

Rationale: The correct answer is C: Elevate the circulating blood volume. Salt-poor albumin is given to increase the circulating blood volume, which helps reduce ascites by improving fluid distribution within the body. Choices A, B, and D are incorrect because salt-poor albumin is not administered to provide nutrients, increase protein stores, or divert blood flow away from the liver.

3. Which lipoprotein carries cholesterol from tissues to the liver for excretion?

• A. Very low-density lipoprotein
• B. Intermediate-density lipoprotein
• C. Low-density lipoprotein
• D. High-density lipoprotein

Correct answer: D

Rationale: The correct answer is D, High-density lipoprotein (HDL). HDL is known as 'good' cholesterol because it helps transport excess cholesterol from tissues back to the liver for removal from the body. Very low-density lipoprotein (VLDL) (choice A) and intermediate-density lipoprotein (choice B) are involved in transporting triglycerides. Low-density lipoprotein (LDL) (choice C) is known as 'bad' cholesterol as it can deposit cholesterol in the walls of arteries.

4. The nurse is analyzing laboratory values for the assigned clients. Which finding, based on the client's medical history, indicates the need for immediate follow-up?

• A. Client with chronic kidney disease and serum creatinine of 1.6 mg/dL
• B. Client with diabetes mellitus and a glycosylated hemoglobin A1c (HbA1c) of 7.0%
• C. Client with heart failure and a B-type natriuretic peptide (BNP) of 140 pg/mL
• D. Client who is male and has anemia with hemoglobin of 16.5 g/dL and hematocrit of 45%

Correct answer: B

Rationale: An HbA1c of 7.0% in a client with diabetes mellitus indicates poor long-term glucose control, necessitating immediate follow-up. Choice A, chronic kidney disease with a serum creatinine of 1.6 mg/dL, though concerning, does not indicate an immediate need for follow-up. Choice C, heart failure with a BNP of 140 pg/mL, may require monitoring but not immediate follow-up. Choice D, a male client with anemia and normal hemoglobin and hematocrit levels, does not warrant immediate attention based on the provided information.

5. The client has recently been diagnosed with irritable bowel syndrome (IBS). Which intervention should the nurse teach the client to reduce symptoms?

• A. Instruct the client to avoid drinking fluids with meals
• B. Explain the need to decrease intake of flatus-forming foods
• C. Teach the client how to perform gentle perianal care
• D. Encourage the client to see a psychologist

Correct answer: B

Rationale: The correct answer is B. Decreasing the intake of flatus-forming foods can help reduce symptoms of bloating and discomfort in IBS. This intervention focuses on dietary modifications that can positively impact the client's condition. Instructing the client to avoid drinking fluids with meals (choice A) may not directly address the underlying cause of IBS symptoms. Teaching perianal care (choice C) is important for hygiene but does not directly address IBS symptoms. Encouraging the client to see a psychologist (choice D) may be beneficial for managing stress or anxiety associated with IBS but does not directly target symptom reduction through dietary changes.

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