Nursing Elites

1. Which of the following actions would be of highest priority with regards to the external shunt?

• A. Avoid taking blood pressure or blood sample from the arm with the shunt
• B. Instruct the patient not to exercise the arm with the shunt
• C. Heparinize the shunt daily
• D. Change the dressing of the shunt daily

Correct answer: C

Rationale: Heparinizing the shunt daily (choice C) is the highest priority action as it prevents the formation of blood clots that can occlude the shunt, leading to potential complications such as thrombosis. Avoiding taking blood pressure or blood samples from the arm with the shunt (choice A) is also important, but secondary to heparinizing the shunt. Similarly, instructing the patient not to exercise the arm with the shunt (choice B) can help prevent unnecessary strain on the shunt, but it is not as critical as preventing clot formation. Changing the dressing of the shunt daily (choice D) is a standard nursing care practice to prevent infection, but again, it is not as critical as ensuring the shunt remains patent through daily heparinization.

2. What is the purpose of a chest tube after a lobectomy procedure, as understood by the nurse?

• A. Prevent mediastinal shift
• B. Promote chest expansion of the remaining lung
• C. Drain fluids and blood accumulated post-operatively
• D. Remove the air in the lungs to promote lung expansion

Correct answer: C

Rationale: After a lobectomy, a chest tube is typically inserted to drain fluids and blood that may have accumulated post-operatively. This tube helps to prevent complications, such as infections or pneumonia, and aids in patient recovery. While a chest tube may aid in preventing a mediastinal shift (Choice A), promoting chest expansion of the remaining lung (Choice B), and removing air in the lungs to promote lung expansion (Choice D), these are not the primary reasons for its use after a lobectomy. Therefore, Choices A, B, and D are incorrect.

3. In comparison to infants born to women of normal weight, infants born to obese women are _____.

• A. less likely to have heart defects
• B. more likely to be of very low birthweight
• C. less likely to experience a complicated birth
• D. more likely to have neural tube defects

Correct answer: D

Rationale: Infants born to obese women are more likely to have neural tube defects compared to infants born to women of normal weight. This increased risk is attributed to factors such as poor maternal nutrition and increased inflammation during pregnancy. Choice A is incorrect because infants born to obese women have a higher risk of heart defects. Choice B is incorrect as infants born to obese women are more likely to have higher birthweights. Choice C is incorrect as obese women are more likely to experience complications during birth.

4. A nurse is caring for a client who has a body mass index (BMI) of 30. Four weeks after nutritional counseling, which of the following evaluation findings indicates the plan of care was followed?

• A. BMI of 25
• B. Weight gain of 1.8 kg
• C. BMI of 33
• D. Weight loss of 2.7 kg

Correct answer: D

Rationale: A weight loss of 2.7 kg in four weeks indicates effective adherence to a nutritional plan aimed at reducing body mass index (BMI), moving towards a healthier weight. Choices A, B, and C are incorrect because a decrease in weight, as shown in choice D, is the desired outcome when managing a client with a BMI of 30 to reach a healthier range.

5. Each of the following is a function of vitamin A, except one. Which is the exception?

• A. Prevention of night blindness
• B. Growth of soft tissues and bone
• C. Maintenance of more than 200 genes
• D. Integrity of body openings and their linings

Correct answer: C

Rationale: The correct answer is C. Maintenance of more than 200 genes is not a function of vitamin A; instead, it is a function of Vitamin D. Vitamin A plays a crucial role in the prevention of night blindness by aiding in the production of the visual pigment rhodopsin. It also supports the growth of soft tissues and bone, as well as the integrity of body openings and their linings. Choice C is incorrect because the maintenance of genes is primarily associated with Vitamin D, not Vitamin A.

Similar Questions