Nursing Elites

1. The PACU nurse will maintain postoperative T and A client in what position?

• A. Supine with neck hyperextended and supported with pillow
• B. Prone with the head on pillow and turned to the side
• C. Semi-fowler’s with neck flexed
• D. Reverse trendelenburg with extended neck

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.

2. In taking the client’s blood pressure, the nurse should position the client’s arm:

• A. At the level of the heart
• B. Slightly above the level of the heart
• C. At the 5th intercostals space midclavicular line
• D. Below the level of the heart

Correct answer: A

Rationale: Proper patient positioning is essential for maximizing lung expansion and promoting the drainage of secretions. Postural drainage techniques rely on gravity to help clear different lung segments, which is critical in preventing complications such as atelectasis or pneumonia in immobilized patients.

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. Which type of bread, cereal, or pasta would most likely be recommended for a patient on a fat-restricted diet?

• A. popcorn
• B. fried rice
• C. English muffins
• D. granola

Correct answer: C

Rationale: English muffins would be the most suitable option for a patient on a fat-restricted diet. They are typically lower in fat compared to fried rice, granola, and popcorn with butter. Popcorn, fried rice, and granola are higher in fat content and may not be the best choice for individuals on a fat-restricted diet.

5. Which foods should be avoided on a low-potassium diet? (SATA)

• A. Bananas
• B. A, C
• C. Sweet potatoes
• D. Frozen corn

Correct answer: B

Rationale: Bananas, sweet potatoes, and orange juice are high in potassium.

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