Nursing Elites

1. The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is:

• A. Verify correct placement of the tube
• B. Check that the feeding solution matches the dietary order
• C. Aspirate gastric contents to determine the amount of the last feeding remaining in the stomach
• D. Ensure that the feeding solution is at room temperature

Correct answer: A

Rationale: The most crucial action for the nurse when preparing to administer enteral feeding via a nasogastric tube is to verify the correct placement of the tube. Proper placement of the tube is vital to prevent complications such as aspiration into the lungs. The definitive methods to confirm the position of the nasogastric tube include visualization through an x-ray or aspirating stomach contents and checking their pH (usually pH 1 to 5). Aspirated stomach content can also be tested for bilirubin to confirm placement in the stomach. Choice B, checking that the feeding solution matches the dietary order, is important for ensuring the correct nutrition is provided but is not as critical as verifying tube placement to prevent potential harm. Choice C, aspirating gastric contents to determine the amount of the last feeding remaining in the stomach, is a common nursing practice but is not the most crucial action when compared to ensuring correct tube placement. Choice D, ensuring that the feeding solution is at room temperature, is relevant for patient comfort and preventing thermal injury but is not as essential as confirming correct tube placement to prevent serious complications.

2. The patient is being taught about pulmonary function testing (PFT). Which statement made by the patient indicates effective teaching?

• A. I will use my inhaler right before the test.
• B. I won't eat or drink anything 8 hours before the test.
• C. I should inhale deeply and blow out as hard as I can during the test.
• D. My blood pressure and pulse will be checked every 15 minutes after the test.

Correct answer: C

Rationale: The correct answer is 'I should inhale deeply and blow out as hard as I can during the test.' This statement indicates effective teaching because for PFT, the patient needs to inhale deeply and exhale forcefully. This maneuver helps in assessing lung function accurately. Choices A, B, and D are incorrect. Using an inhaler right before the test may alter the test results, which is not recommended. Fasting for 8 hours is not necessary for a PFT, and checking blood pressure and pulse every 15 minutes after the test is not part of the PFT procedure.

3. A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

• A. IgA
• B. IgD
• C. IgE
• D. IgG

Correct answer: D

Rationale: IgG is the only immunoglobulin that can cross the placental barrier, providing passive immunity to the fetus. About 70-80% of the immunoglobulins in the blood are IgG. Specific IgG antibodies are generated after an initial exposure to an antigen, offering long-term protection against microorganisms. IgG antibodies are critical for protecting the fetus as they can be rapidly reproduced upon re-exposure to the same antigen. IgA is primarily found in mucosal areas, IgD is involved in antigen recognition, and IgE is associated with allergic reactions, but they do not provide the same level of protection to the fetus as IgG.

4. Application - The nurse is caring for a patient who has the following labs: Creatinine 2.5mg/dL, WBC 11,000 cells/mL, and Hemoglobin of 12 g/dL. Based on this information, which of these orders would the nurse question?

• A. Administer 30 Units of Lantus Daily
• B. CT of the spine with contrast
• C. X-ray of the abdomen and chest
• D. Administer heparin subcutaneously 5,000 Units every 12 hours

Correct answer: B

Rationale: The correct answer is to question the order for a CT of the spine with contrast. The patient's elevated creatinine level of 2.5mg/dL indicates impaired kidney function. Contrast agents are nephrotoxic and can further compromise kidney function in patients with existing nephropathy. Therefore, it is crucial to avoid contrast-enhanced imaging studies in patients with impaired renal function. Choice A: Administering 30 Units of Lantus Daily is not contraindicated based on the provided lab values. Choice C: Ordering an X-ray of the abdomen and chest is not contraindicated based on the provided lab values. Choice D: Administering heparin subcutaneously at 5,000 Units every 12 hours is not contraindicated based on the provided lab values.

5. When caring for a patient with Parkinson's Disease, which of the following practices would not be included in the care plan?

• A. Decrease the calorie content of daily meals to avoid weight gain
• B. Allow the patient extra time to respond to questions and perform ADLs
• C. Use thickened liquids and a soft diet
• D. Encourage the patient to hold the spoon when eating

Correct answer: A

Rationale: The correct answer is to decrease the calorie content of daily meals to avoid weight gain. Patients with Parkinson's Disease often experience dysphagia (difficulty swallowing) and muscle rigidity, which can lead to weight loss. Therefore, increasing calorie intake is essential to meet their nutritional needs. Choice A is incorrect because reducing calories can worsen malnutrition in these patients. Choices B, C, and D are appropriate interventions for patients with Parkinson's Disease. Allowing extra time for tasks, using thickened liquids and a soft diet for swallowing difficulties, and encouraging self-feeding promote independence and safety in eating.

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