Nursing Elites

1. The following are appropriate nursing interventions during colostomy irrigation, EXCEPT:

• A. Increase the irrigating solution flow rate when abdominal cramps is felt
• B. Insert 2-4 inches of an adequately lubricated catheter to the stoma
• C. Position client in semi-Fowler
• D. Hang the solution 18 inches above the stoma

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. What is your estimate of the population of pregnant woman needing tetanus toxoid vaccination?

• A. 632.5 C. 450.5
• B. 512.5 D. 332.5
• C.
• D.

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.

3. A Hazard Analysis and Critical Control Points (HACCP) program would address which element of food service?

• A. cleaning and disinfecting of utensils
• B. developing healthy menus
• C. controlling patient calorie intake
• D. prescribing diets for patients with swallowing problems

Correct answer: A

Rationale: The correct answer is A. Hazard Analysis and Critical Control Points (HACCP) programs are designed to ensure food safety by identifying and controlling potential hazards. This includes addressing the cleaning and disinfecting of utensils to prevent contamination and maintain safe food handling practices. Choices B, C, and D are incorrect because HACCP primarily focuses on preventing food safety hazards rather than developing menus, controlling calorie intake, or prescribing diets for specific medical conditions.

4. To ensure client safety before starting blood transfusions, the following are needed before the procedure can be done EXCEPT:

• A. take baseline vital signs
• B. warm the blood to room temperature for 30 minutes before administering the transfusion
• C. have two nurses verify client identification, blood type, unit number, and expiration date of blood
• D. get consent signed for blood transfusion

Correct answer: D

Rationale: To ensure client safety before starting blood transfusions, taking baseline vital signs, warming the blood to room temperature, and having two nurses verify client identification, blood type, unit number, and expiration date of blood are crucial steps. Consent for blood transfusion is required but is typically obtained before the procedure. The focus before the procedure should be on confirming the right client, blood product, and ensuring the blood is prepared correctly to minimize risks of transfusion reactions.

5. Can fluid retention cause lab values to be deceptively high, whereas dehydration may cause the values to be deceptively low?

• A. TRUE
• B. FALSE
• C. Not always
• D. Sometimes

Correct answer: B

Rationale: The statement is incorrect. Fluid retention generally results in lab values appearing deceptively low, not high, because the excess fluid dilutes the concentration of substances in the blood. Conversely, dehydration can make lab values appear deceptively high as the reduced fluid volume in the body means substances in the blood are less diluted. Choices 'C: Not always' and 'D: Sometimes' are not specific and do not directly address the statement in the question, hence they are incorrect.

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