Nursing Elites

1. In conducting a cleansing enema, how does the nurse position the client?

• A. Right lateral position
• B. Left lateral position
• C. Right Sim's position
• D. Left Sim's position

Correct answer: B

Rationale: In preparing a patient for a cleansing enema, the nurse typically positions the patient in the left lateral position. This position allows for the best flow of the solution due to the anatomical configuration of the colon. The right lateral position, right Sim's position, and left Sim's position are not typically used for this procedure. The rationale provided initially is incorrect as it pertains to lung expansion and postural drainage, which are not relevant to a cleansing enema procedure.

2. The nurse is caring for an infant whose parent reports the infant takes a bottle to go to sleep. What should the nurse instruct to prevent baby bottle tooth decay?

• A. Water
• B. Milk
• C. Iron-fortified formula
• D. Unsweetened fruit juice

Correct answer: A

Rationale: The correct answer is A, Water. Water is recommended to prevent baby bottle tooth decay caused by sugary substances present in milk, formula, or fruit juice. Water does not contain sugars that can contribute to tooth decay, unlike the other options. Milk, formula, and unsweetened fruit juice can all lead to tooth decay if the baby falls asleep with them in their mouth, as the sugars can linger on the teeth and cause decay over time. Iron-fortified formula, although beneficial for the infant's nutrition, still contains sugars that can be harmful to the teeth.

3. If the child does not have ear problem, using IMCI, what should you as the nurse do?

• A. Check for ear discharge
• B. Check for tender swellings behind the ear
• C. Check for ear pain
• D. Go to the next question, check for malnutrition

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.

4. Select all that apply. Which of the following oils contain high levels of unsaturated fatty acids and low levels of saturated and trans fats?

• A. vegetable oil
• B. palm oil
• C. coconut oil
• D. canola oil

Correct answer: A

Rationale: Vegetable, canola, and olive oils are high in unsaturated fats and low in saturated and trans fats, making them heart-healthy choices.

5. A nurse is instructing a group of clients about nutrition. The nurse should include that which of the following is a trigger for the formation of vitamin D in the body?

• A. Calcium
• B. Vitamin A depletion
• C. Exposure to sunlight
• D. Weight-bearing exercise

Correct answer: C

Rationale: Exposure to sunlight is the trigger for the formation of vitamin D in the body. When the skin is exposed to sunlight, it produces vitamin D. This process is essential for maintaining healthy levels of vitamin D in the body. Calcium (Choice A) is important for bone health but is not the trigger for vitamin D formation. Vitamin A depletion (Choice B) does not directly trigger the formation of vitamin D. Weight-bearing exercise (Choice D) is crucial for bone health but is not directly related to the formation of vitamin D.

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