Nursing Elites

1. Discharge plans of diabetic clients include injection site rotation. You should emphasize that the space between sites should be:

• A. 6.0 cm.
• B. 5.0 cm.
• C. 2.5 cm.
• D. 4.0 cm.

Correct answer: A

Rationale: Patient safety and efficacy of care depend on actions rooted in established nursing protocols that consider both the immediate and long-term needs of the patient.

2. Because of increasing cases of fluorosis, low levels of fluoride are added to commercial infant formula. Breast milk provides low levels of fluoride.

• A. Both statements are true
• B. Both statements are false
• C. The first statement is true; the second is false
• D. The first statement is false; the second is true

Correct answer: D

Rationale: The first statement is false; fluoride is not added to infant formulas due to the risk of fluorosis. The second statement is true; breast milk contains low levels of fluoride.

3. Which symptoms are associated with cancer of the colon?

• A. constipation, ascites, and mucus in the stool
• B. diarrhea, heartburn, and eructation
• C. blood in the stools, anemia, and 'pencil-shaped' stools
• D. anorexia, hematemesis, and increased peristalsis

Correct answer: C

Rationale: The correct symptoms associated with cancer of the colon are blood in the stools, anemia, and 'pencil-shaped' stools. These symptoms are classic indicators of colorectal cancer. Choices A, B, and D do not typically present in colorectal cancer. Constipation, ascites, and mucus in the stool are more commonly associated with other gastrointestinal conditions. Diarrhea, heartburn, and eructation are not typical symptoms of colon cancer. Anorexia, hematemesis, and increased peristalsis are more indicative of other gastrointestinal issues and not specific to colon cancer.

4. The purpose of chest percussion and vibration is to loosen secretions in the lungs. The difference between the procedures is:

• A. Percussion uses only one hand, while vibration uses both hands
• B. Percussion delivers cushioned blows to the chest with cupped palms, while vibration gently shakes secretions loose
• C. In both percussion and vibration, the hands are not on top of each other, and hand action is not in tune with the client's breath
• D. Percussion slaps the chest to loosen secretions, while vibration shakes the secretions along with the inhalation

Correct answer: D

Rationale: Chest percussion involves the use of rhythmic tapping to dislodge mucus from the lungs, facilitating its movement toward the larger airways where it can be expelled. This technique is particularly important in conditions where mucus retention is a significant risk factor for infection. The key difference between chest percussion and vibration is that percussion involves slapping the chest to loosen secretions, while vibration involves shaking the secretions along with the inhalation, aiding in moving the loosened secretions upwards for easier removal. Choices A, B, and C do not accurately describe the main difference between chest percussion and vibration, making them incorrect.

5. Which of the following are examples of mechanical digestion? Select all that apply.

• A. Heat
• B. Segmentation
• C. Option B and D
• D. Peristalsis

Correct answer: C

Rationale: Mechanical digestion involves physical movements that break down food in the digestive tract. Segmentation (choice B) and peristalsis (choice D), which are both movements of the muscles in the digestive tract, are examples of this type of digestion. Heat (choice A), on the other hand, is related to chemical digestion, not mechanical digestion. Therefore, choice C (Option B and D) is the correct answer as it includes both examples of mechanical digestion provided in the choices. Choices A and D are incorrect because heat (choice A) is not a mechanical digestion process, and peristalsis (choice D) is a movement that helps propel food along the digestive tract but is not directly involved in breaking down food physically.

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