Nursing Elites

1. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as:

• A. counselor
• B. mother surrogate
• C. therapist
• D. socializing agent

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. The nurse is correct in performing suctioning when she applies the suction intermittently during:

• A. Insertion of the suction catheter
• B. Withdrawing of the suction catheter
• C. both insertion and withdrawing of the suction catheter
• D. When the suction catheter tip reaches the bifurcation of the trachea

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. 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.

4. A nurse is planning care for a client who has ascites secondary to liver disease. Which of the following interventions should the nurse include in the plan of care?

• A. Reduce complex carbohydrates to 30% of total calories.
• B. Restrict protein intake to less than 0.8 g/kg/day.
• C. Decrease daily caloric intake by 20%.
• D. Limit sodium to 2000 mg or less per day.

Correct answer: D

Rationale: The correct answer is to limit sodium to 2000 mg or less per day. Ascites, which is the abnormal accumulation of fluid in the abdominal cavity, is commonly associated with liver disease. Limiting sodium intake helps manage fluid retention by reducing the fluid accumulation in the abdomen. Choices A, B, and C are incorrect because reducing complex carbohydrates, restricting protein intake, or decreasing caloric intake are not the primary interventions for managing ascites in liver disease.

5. Each is a portion of the alimentary canal, except one. Which is the exception?

• A. Oral cavity
• B. Pharynx
• C. Larynx
• D. Esophagus

Correct answer: C

Rationale: The correct answer is C, Larynx. The larynx is part of the respiratory system, responsible for voice production and breathing. The alimentary canal is involved in the digestive process and includes structures like the oral cavity (mouth), pharynx, and esophagus. Choices A, B, and D are parts of the alimentary canal, where digestion occurs, making them incorrect answers.

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