Nursing Elites

1. In consideration of the steps in applying the bag technique, which side of the paper lining of the CHN bag is considered clean to make a non-contaminated work area?

• A. The lower lip
• B. The outer surface
• C. The upper tip
• D. The inside surface

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 at a provider's office is providing teaching to a client who is taking chemotherapy and losing weight. Which of the following should the nurse recommend to increase calorie and protein intake? (Select one that does not apply.)

• A. Top yogurt with fruits.
• B. Add cream to soups.
• C. Use milk instead of water in recipes.
• D. Increase fluids during meals.

Correct answer: D

Rationale: The correct recommendation to increase calorie and protein intake for a client taking chemotherapy and losing weight is to add cream to soups (choice B), as it provides additional calories and proteins. Using milk instead of water in recipes (choice C) can also increase the calorie and protein content. Topping yogurt with fruits (choice A) can be a healthy choice but may not significantly increase calorie and protein intake. Increasing fluids during meals (choice D) may fill up the stomach, potentially reducing the intake of solid foods, which is not ideal when trying to increase calorie and protein consumption.

3. 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.

4. What are sheets/forms that provide an efficient and time-saving way to record information that must be obtained repeatedly at regular and/or short intervals of time? This does not replace progress notes; instead, it records information on vital signs, intake and output, treatment, postoperative care, postpartum care, and diabetic regimen, etc. These are used whenever specific measurements or observations need to be documented repeatedly. What is this?

• A. Nursing Kardex
• B. Graphic Flow Sheets
• C. Discharge Summary
• D. Medicine and Treatment Record

Correct answer: A

Rationale: The correct answer is A, Nursing Kardex. Nursing Kardex is a tool used for documenting essential patient information that needs to be recorded repeatedly at regular intervals. It includes vital signs, intake and output, treatment details, postoperative care, postpartum care, and diabetic regimen. This tool is efficient and time-saving for healthcare professionals. Choice B, Graphic Flow Sheets, may be used for visual representation of patient data but is not specifically designed for repeated documentation of essential information. Choice C, Discharge Summary, is a document outlining the patient's care and condition at the time of discharge, not for repeated recording of ongoing data. Choice D, Medicine and Treatment Record, focuses more on specific medications and treatments rather than a comprehensive recording of various patient data needed at regular intervals.

5. A nurse is planning to teach a client about a low-potassium diet. Which of the following foods should the nurse instruct the client to avoid?

• A. Butter
• B. Poultry
• C. Yogurt
• D. Orange juice

Correct answer: D

Rationale: Orange juice is high in potassium and should be avoided in a low-potassium diet. Butter, poultry, and yogurt are low-potassium food choices and can be included in a low-potassium diet. Poultry is a good source of lean protein, yogurt is a good source of calcium and protein, and butter is low in potassium. Therefore, the nurse should instruct the client to avoid orange juice as it is high in potassium, which is not suitable for a low-potassium diet.

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