Nursing Elites

1. While on Bryant’s traction, which of these observations of Graciela and her traction apparatus would indicate a decrease in the effectiveness of her traction?

• A. Graciela’s buttocks are resting on the bed.
• B. The traction weights are hanging 10 inches above the floor.
• C. Graciela’s legs are suspended at a 90 degree angle to her trunk.
• D. The traction ropes move freely through the pulley.

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.

2. In a patient with liver cirrhosis, weight gain due to fluid retention can mask the symptoms of what condition?

• A. Liver failure
• B. Gallbladder disease
• C. Heart failure
• D. Protein-Energy Malnutrition (PEM)

Correct answer: D

Rationale: In a patient with liver cirrhosis, weight gain due to fluid retention can mask Protein-Energy Malnutrition (PEM) symptoms. This can lead to an increase in weight, making it challenging to identify weight loss or muscle wasting associated with PEM. Therefore, option D is correct. Options A, B, and C are incorrect because fluid retention and weight gain related to liver cirrhosis do not necessarily hide the symptoms of liver failure, gallbladder disease, or heart failure.

3. Aling Maria is nearing menopause. She is habitually taking cola and coffee for the past 20 years. You should tell Aling Maria to avoid taking caffeinated beverages because:

• A. It is stimulating
• B. It will cause nervousness and insomnia
• C. It will contribute to additional bone demineralization
• D. It will cause tachycardia and arrhythmias

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.

4. Which client is most likely to need regular injections of vitamin B12?

• A. The client with malabsorption syndrome.
• B. The client following a vegan eating pattern.
• C. The client whose stomach does not produce intrinsic factors.
• D. The client with alcoholism.

Correct answer: C

Rationale: The correct answer is C. The client whose stomach does not produce intrinsic factors is most likely to need regular injections of vitamin B12. Intrinsic factor is essential for the absorption of vitamin B12. Without intrinsic factor, the client cannot absorb vitamin B12 from food, necessitating the need for regular injections. Choices A, B, and D do not directly impact the production of intrinsic factors in the stomach, so they are less likely to result in the need for vitamin B12 injections.

5. Which systolic blood pressure measurement is classified as prehypertension?

• A. 106 mmHg
• B. 119 mmHg
• C. 130 mmHg
• D. 141 mmHg

Correct answer: B

Rationale: According to the blood pressure classification, a systolic blood pressure between 120-139 mmHg is considered prehypertension. This range indicates an increased risk for developing hypertension if not managed appropriately. Therefore, a systolic blood pressure of 119 mmHg falls into the prehypertension category. A systolic pressure of 106 mmHg is within the normal range, while 130 mmHg and above would be classified as stage 1 and stage 2 hypertension respectively, not prehypertension.

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