Nursing Elites

1. The nurse is working with a patient who recently had a stroke. The patient frequently chokes and coughs when eating and is having difficulty feeding herself. What is the best way to ensure adequate nutrition?

• A. to have an aide feed her at each meal
• B. to ask a family member to assist during meals
• C. to provide tube feedings for the patient
• D. to initiate TPN for the patient

Correct answer: C

Rationale: The best way to ensure adequate nutrition for a stroke patient who frequently chokes and coughs when eating and has difficulty feeding herself is to provide tube feedings. Tube feedings are a safe and effective method to deliver nutrition directly to the stomach or intestines, bypassing the swallowing mechanism, reducing the risk of aspiration. Having an aide feed her each meal (choice A) may not address the underlying issue of swallowing difficulty and aspiration risk. Asking a family member to be present at each meal (choice B) does not provide a definitive solution to the patient's nutritional needs. Placing the patient on total parenteral nutrition (TPN) (choice D) is a more invasive and typically reserved for patients who cannot tolerate enteral feedings or have non-functional gastrointestinal tracts.

2. What side effect is commonly associated with ECT?

• A. Transient loss of memory, confusion, and disorientation
• B. Nausea and vomiting
• C. Fractures
• D. Hypertension and increased heart rate

Correct answer: A

Rationale: The correct answer is A, as Electroconvulsive Therapy (ECT) is commonly associated with side effects such as transient loss of memory, confusion, and disorientation. While nausea and vomiting (Choice B) can occur, they are not as common as the memory-related side effects. Fractures (Choice C) are unlikely unless a mishap occurs during the procedure. Hypertension and increased heart rate (Choice D) might occur during the procedure due to the physiological stress of the treatment, but these are not the most commonly associated side effects. The rationale provided did not effectively explain this, so it's important to note that ECT is a procedure often used for severe depression and other mental illnesses, and understanding its side effects is crucial for patient safety and effective care.

3. You are on duty in the medical ward. You were asked to check the narcotics cabinet. You found out that what is on record does not tally with the drugs used. What will you do first?

• A. Write an incident report and refer the matter to the nursing director
• B. Keep your findings to yourself
• C. Report the matter to your supervisor
• D. Find out from the endorsement any patient who might have been given narcotics

Correct answer: C

Rationale: In this situation, the first step should be to report the matter to your supervisor. It is essential to notify the appropriate authority immediately to address the discrepancy in the narcotics cabinet. Choice A is not the first step as reporting to the nursing director should follow after informing the supervisor. Keeping the findings to yourself (Choice B) is not appropriate as it may jeopardize patient safety and is against ethical standards. While finding out which patient received narcotics (Choice D) is important, it is not the immediate action to take in this scenario.

4. When is infertility said to exist?

• A. When a woman has no uterus
• B. When a woman has no children
• C. When a couple has been trying to conceive for 1 year without success
• D. When a couple has desired a child for 6 months

Correct answer: C

Rationale: Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples. Therefore, the correct answer is C. A, B, and D are incorrect. While having no uterus (choice A) may result in infertility, it is not the sole determining factor. Similarly, not having children (choice B) does not automatically indicate infertility. Lastly, the time frame of 6 months (choice D) is not sufficient to determine infertility; typically, a year of trying without success is required for such a diagnosis.

5. What are the potential consequences of damage to the stomach?

• A. Reduced digestion of carbohydrates
• B. Inability to produce or secrete bile
• C. Inability to produce or secrete gastric acid
• D. Increased ability to produce or secrete intrinsic factor

Correct answer: C

Rationale: Damage to the stomach can lead to a reduced ability to produce gastric acid (Choice C) and intrinsic factor, the latter of which is crucial for vitamin B12 absorption (Choice D). That's why these two choices are correct. The stomach doesn't play a direct role in the digestion of carbohydrates (Choice A) as this process primarily occurs in the small intestine with the help of pancreatic enzymes. Similarly, bile is produced by the liver and stored in the gallbladder, not the stomach, hence stomach damage wouldn't lead to an inability to produce or secrete bile (Choice B).

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