Nursing Elites

1. Where should a nurse auscultate the apex beat?

• A. At the fifth intercostal space, along the midclavicular line
• B. At the mid-sternum
• C. 2 inches to the left of the lower end of the sternum
• D. 1 inch to the left of the xiphoid process

Correct answer: A

Rationale: The correct location to auscultate the apex beat is at the fifth intercostal space, along the midclavicular line. This is where the apical impulse, also known as the point of maximal impulse (PMI), can be best heard. Choices B, C, and D are incorrect anatomical locations for auscultating the apex beat, which makes them incorrect choices. Auscultating at the correct location allows healthcare providers to assess the heart's function and detect any abnormalities in heart sounds, which is crucial for comprehensive patient care.

2. Before administration of blood and blood products, the nurse should first:

• A. Check with another R.N the client’s name, Identification number, ABO and RH type.
• B. Explain the procedure to the client
• C. Assess baseline vital signs of the client
• D. Check for the BT order

Correct answer: C

Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.

3. What is the function of the gallbladder?

• A. to store bile
• B. to produce bile
• C. to digest bile
• D. to modify bile to a liquid form

Correct answer: A

Rationale: The correct answer is A: "to store bile." The gallbladder acts as a reservoir for bile produced by the liver. It releases bile into the small intestine to aid in the digestion of fats. Choice B is incorrect because the liver produces bile, not the gallbladder. Choice C is incorrect as the gallbladder does not digest bile but stores and releases it for digestion. Choice D is incorrect because bile is already in liquid form; the gallbladder does not modify it to a liquid state.

4. When assessing older adult clients for malnutrition at an adult day care center, which risk factors should the nurse consider?

• A. Dental problems
• B. Depression
• C. Both A and B
• D. Ability to prepare meals

Correct answer: C

Rationale: The correct answer is C: Both A and B. Dental problems and depression are both significant risk factors for malnutrition in older adults. Dental problems can lead to difficulty in chewing and swallowing, resulting in reduced food intake. On the other hand, depression can cause changes in appetite and decreased interest in eating, which can also contribute to malnutrition. Although the ability to prepare meals is important, it is not specifically identified as a risk factor for malnutrition within the context of this question. Therefore, choices A and B are the most appropriate answers.

5. Which of the following is a common sign of vitamin D deficiency?

• A. Brittle nails
• B. Muscle weakness
• C. Night blindness
• D. Hair loss

Correct answer: B

Rationale: Muscle weakness is a common sign of vitamin D deficiency. Vitamin D is essential for calcium absorption and bone health, and its deficiency can lead to muscle weakness. Brittle nails (Choice A) are not typically associated with vitamin D deficiency. Night blindness (Choice C) is related to vitamin A deficiency, not vitamin D deficiency. Hair loss (Choice D) can be linked to various factors, but it is not a common sign of vitamin D deficiency.

Similar Questions