Nursing Elites

1. You are to measure the client's initial blood pressure reading by doing all of the following EXCEPT:

• A. Take the blood pressure reading on both arms for comparison
• B. Listen to and identify the phases of Korotkoff sounds
• C. Pump the cuff to around 50 mmHg above the point where the pulse is obliterated
• D. Observe procedures for infection control

Correct answer: B

Rationale: When measuring blood pressure, it is crucial to follow specific steps to obtain accurate readings. Taking the blood pressure on both arms for comparison helps assess any variations. Pumping the cuff to around 50 mmHg above the point of pulse obliteration ensures accurate measurements. Observing procedures for infection control is vital to prevent the spread of infections. Listening to and identifying the phases of Korotkoff sounds are associated with auscultatory blood pressure measurements, not the initial blood pressure reading process.

2. A nurse is caring for a client following an appendectomy. The nurse verifies the postoperative prescription which reads, 'Discontinue NPO status; advance diet as tolerated.' Which of the following are appropriate for the nurse to offer the client? (SATA)

• A. Wheat toast
• B. Applesauce
• C. Applesauce, Chicken broth
• D. Chicken broth

Correct answer: C

Rationale: The correct answer is C: Applesauce and chicken broth. After an appendectomy, patients are typically started on a clear liquid diet before advancing to more solid foods. Applesauce and chicken broth are part of a low-residue diet that is easily digestible and gentle on the digestive system, making them suitable choices for a client following surgery. Wheat toast may be too heavy and fibrous initially, while other solid foods should be introduced gradually to prevent gastrointestinal upset.

3. When injecting subcutaneous injection in an obese patient, It should be angled at around:

• A. 45 °
• B. 90 °
• C. 180 °
• D. Parallel to the skin

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.

4. What principle is used when the client with fever loses heat through giving cooling bed bath to lower body temperature?

• A. Radiation C. Evaporation
• B. Convection D. Conduction
• 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.

5. By the age of three, which age-appropriate food skill can a child typically perform?

• A. Using utensils and a napkin
• B. Spearing food with a fork
• C. Measuring liquids
• D. Displaying proper table manners

Correct answer: B

Rationale: By the age of three, a child typically develops the motor skills needed to spear food with a fork. This is a critical milestone in self-feeding as it shows progress in fine motor coordination. Choice 'A' is incorrect because using utensils and a napkin properly is a skill that may take longer to develop and refine. Choice 'C' is not correct as measuring liquids requires a higher level of motor skills and understanding of quantities that a three-year-old child might not possess. Choice 'D' is also incorrect as the proper display of table manners is a complex skill that is typically learned over a longer period and involves social and cultural norms.

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