Nursing Elites

1. During the first 24 hours after the thermal injury, you should assess Sergio for:

• A. hypokalemia and hypernatremia
• B. hypokalemia and hyponatremia
• C. hyperkalemia and hyponatremia
• D. hyperkalemia and hypernatremia

Correct answer: D

Rationale: During the initial phase after a thermal injury, the major concern is the release of potassium due to cell damage, leading to hyperkalemia. Hypernatremia is not typically a primary concern in the immediate post-injury phase. Hyponatremia is less likely to occur initially after a burn injury. Therefore, the correct assessment for Sergio during the first 24 hours after the thermal injury would be hyperkalemia and hypernatremia.

2. After consuming a meal high in fat, the _____ releases _______ to aid in digestion.

• A. stomach, acid
• B. liver, bile
• C. pancreas, bicarbonate
• D. gallbladder, bile

Correct answer: D

Rationale: The gallbladder releases bile into the small intestine to help digest fats. Bile emulsifies fats, breaking them down into smaller droplets for easier digestion. The stomach primarily releases gastric acid, the liver produces bile but stores it in the gallbladder, and the pancreas secretes bicarbonate to neutralize stomach acid in the small intestine. Therefore, choices A, B, and C are incorrect.

3. A nurse is providing nutritional education to a client who is obese. The nurse should include in the information that which of the following gastrointestinal disorders is commonly associated with obesity?

• A. Peptic ulcer disease
• B. Gastroesophageal reflux disease
• C. Celiac disease
• D. Crohn’s disease

Correct answer: B

Rationale: Gastroesophageal reflux disease (GERD) is commonly associated with obesity due to increased abdominal pressure and other factors. Peptic ulcer disease (Choice A) is not commonly associated with obesity. Celiac disease (Choice C) is an autoimmune disorder triggered by gluten consumption and is not directly linked to obesity. Crohn’s disease (Choice D) is a type of inflammatory bowel disease and is not specifically associated with obesity.

4. After cleaning the abrasions and applying antiseptic, the nurse applies a cold compress to the swollen ankle as ordered by the physician. This statement shows that the nurse has a correct understanding of the use of a cold compress:

• A. Cold compress reduces blood viscosity in the affected area
• B. It is safer to apply than a hot compress
• C. Cold compress prevents edema and reduces pain
• D. It eliminates toxic waste products due to vasodilation

Correct answer: C

Rationale: The correct understanding of using a cold compress includes knowing that it helps prevent edema and reduces pain. Cold application constricts blood vessels, reducing blood flow to the area, which helps decrease swelling and pain. Choices A, B, and D are incorrect because cold compresses do not directly affect blood viscosity, safety compared to hot compresses, or eliminate toxic waste products due to vasodilation. It is essential for nurses to have a clear understanding of the rationale behind interventions to provide effective patient care.

5. A nurse is providing MyPlate education to a client newly diagnosed with diabetes mellitus. Which plate chosen by the client indicates the teaching was effective, according to the MyPlate guidelines?

• A. 1/2 of the plate is filled with carbohydrate foods, 1/4 filled with protein foods, and 1/4 filled with fruits and vegetables
• B. 1/2 of the plate is filled with protein foods, 1/4 filled with carbohydrates, and 1/4 filled with non-starchy vegetables
• C. 1/2 of the plate is filled with carbohydrates, 1/4 filled with protein foods, and 1/4 filled with non-starchy vegetables
• D. 1/2 of the plate is filled with non-starchy vegetables, 1/4 filled with protein foods, and 1/4 filled with carbohydrate foods

Correct answer: D

Rationale: The correct answer is D. This option reflects the MyPlate guidelines for managing diabetes effectively. In diabetes management, it is essential to focus on non-starchy vegetables, appropriate protein portions, and controlled carbohydrate intake. Option A places too much emphasis on carbohydrates, which may not be suitable for diabetes. Option B swaps the proportions of protein and carbohydrates, which is not in line with the recommended distribution. Option C places too much emphasis on carbohydrates and lacks the emphasis on non-starchy vegetables, making it less suitable for diabetes management.

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