Nursing Elites

1. How does the procedure for taking a pulse rate on an infant differ from an adult?

• A. Pulse rates are taken on infants using a different method.
• B. The apical pulse method is used on infants.
• C. Pulse rates on infants are taken with a sphygmomanometer.
• D. Pulse rates on infants are taken apically in the third intercostal space.

Correct answer: B

Rationale: The correct answer is B: The apical pulse method is used on infants. This method involves placing a stethoscope in the fifth intercostal space, mid-clavicular line, and counting the beats for a full minute. It is a preferred method for infants due to their small size and the difficulty in palpating peripheral pulses accurately. Choices A, C, and D are incorrect. Choice A is incorrect as pulse rates are indeed taken on infants, albeit using a different method. Choice C is incorrect as a sphygmomanometer is typically used for measuring blood pressure, not pulse rates. Choice D is incorrect as pulse rates on infants are usually taken apically in the fifth intercostal space, not the third.

2. During which part of the client interview would it be best for the nurse to ask, 'What's the weather forecast for today?'

• A. Introduction
• B. Body
• C. Closing
• D. Orientation

Correct answer: A

Rationale: Asking about the weather initiates the social or introductory phase of the interview, allowing the nurse to establish rapport with the client at the beginning. This question can help assess the client's mental status and set a friendly tone. In the body phase, the client responds to the nurse's inquiries, while during the closing phase, either the nurse or the client concludes the interview. Therefore, the best time to ask about the weather forecast is during the introduction phase to facilitate a positive start to the interaction.

3. The healthcare professional is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope?

• A. Used to listen for high-pitched sounds
• B. Used to listen for low-pitched sounds
• C. Should be firmly held against the person's skin to block out low-pitched sounds
• D. Should be lightly held against the person's skin to listen for extra heart sounds and murmurs

Correct answer: A

Rationale: The diaphragm of the stethoscope is designed for listening to high-pitched sounds like breath, bowel, and normal heart sounds. It should be firmly held against the person's skin to ensure optimal sound transmission, leaving a ring after use. On the other hand, the bell of the stethoscope is ideal for detecting soft, low-pitched sounds such as extra heart sounds or murmurs. Therefore, the diaphragm is not used to block out low-pitched sounds but rather to enhance the detection of high-frequency sounds.

4. A nurse is preparing to irrigate a client's indwelling catheter through a closed, intermittent system. Which of the following steps must the nurse take as part of this process?

• A. Use sterile solution at room temperature
• B. Position the client in a comfortable position
• C. Clamp the catheter at the level above the injection port
• D. Inject sterile solution through the injection port into the catheter

Correct answer: D

Rationale: When performing closed intermittent system catheter irrigation, the nurse should use sterile solution at room temperature with sterile technique. It is important to position the client comfortably for easy access to the catheter site and to assess the abdomen during the procedure. Clamping the catheter should be done below the level of the injection port, not above. The correct step is to inject sterile solution through the injection port into the catheter, allowing the fluid to travel up the catheter to irrigate the tubing and the bladder.

5. The mitral valve is synonymous with the term:

• A. Left ventricle
• B. Right atrium
• C. Bicuspid valve
• D. Tricuspid valve

Correct answer: C

Rationale: The mitral valve, also known as the bicuspid valve, is located between the left atrium and the left ventricle, regulating blood flow from the left atrium into the left ventricle. The term 'bicuspid' refers to the valve's two cusps or leaflets. This distinguishes it from the tricuspid valve (Choice D), which has three cusps, making Choice D incorrect. The left ventricle (Choice A) and right atrium (Choice B) are not synonymous with the mitral valve. Therefore, the correct answer is C: Bicuspid valve.

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