Nursing Elites

1. What nursing diagnosis would be most appropriate for a patient with heart failure?

• A. risk for infection
• B. fluid volume excess
• C. impaired body temperature
• D. ineffective airway clearance

Correct answer: B

Rationale: The most appropriate nursing diagnosis for a patient with heart failure is 'fluid volume excess.' In heart failure, the heart's reduced pumping ability leads to fluid retention, causing an excess of fluid in the body. This can result in symptoms such as edema, shortness of breath, and weight gain. 'Risk for infection,' 'impaired body temperature,' and 'ineffective airway clearance' are not the most appropriate nursing diagnoses for a patient with heart failure as they do not directly relate to the pathophysiology and common issues seen in heart failure patients.

2. The past history of Camila would most probably reveal that her premorbid personality is:

• A. schizoid
• B. extrovert
• C. ambivert
• D. cycloid

Correct answer: D

Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.

3. A paranoid client refuses to eat telling you that you poisoned his food. The best intervention to this client is:

• A. Taste the food in front of him and tell him that the food is not poisoned
• B. Offer other types of food until the client eats
• C. Simply state that the food is not poisoned
• D. Offer sealed foods

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.

4. A client who practices Islam and is currently observing dietary restrictions for the month of Ramadan. Which of the following interventions should the nurse include in the plan of care?

• A. Remove pork products from the dietary plan
• B. Facilitate fasting during daylight hours
• C. Serve meat and dairy items together
• D. Provide a low-carb diet on Fridays

Correct answer: B

Rationale: During Ramadan, individuals fast from dawn to sunset. Facilitating fasting during daylight hours respects the dietary practices of clients observing Ramadan. Choice A is incorrect as the dietary restriction during Ramadan involves abstaining from all food and drink during daylight hours, not just beef products. Choice C is incorrect as Muslims generally do not consume meat and dairy together due to religious dietary laws. Choice D is incorrect as providing a low-carb diet on Fridays does not specifically align with the dietary restrictions observed during Ramadan.

5. Induction of vomiting is indicated for the accidental poisoning patient who has ingested.

• A. Rust remover C. toilet bowl cleaner
• B. Gasoline D. aspirin
• C.
• D.

Correct answer: D

Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.

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