Nursing Elites

1. 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.

2. Ms. Maria Salvacion says that she is the incarnation of the holy Virgin Mary. She said that she is the child of the covenant that would save this world from the evil forces of Satan. One morning, while caring for her, she stood in front of you and said “Bow down before me! I am the holy mother of Christ! I am the blessed Virgin Mary!” The best response by the Nurse is:

• A. Tell me more about being the Virgin Mary
• B. So, You are the Virgin Mary?
• C. Excuse me but, you are not anymore a Virgin so you cannot be the Blessed Virgin Mary.
• D. You are Maria Salvacion

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.

3. The nurse notes that the fall might also cause a possible head injury. The patient will be observed for signs of increased intracranial pressure which include:

• A. Narrowing of the pulse pressure
• B. Vomiting
• C. Periorbital edema
• D. A positive Kernig's sign

Correct answer: C

Rationale: Periorbital edema is a sign of increased intracranial pressure. It is caused by fluid accumulation around the eyes due to compromised drainage. Narrowing of the pulse pressure is more indicative of shock than increased intracranial pressure. While vomiting can be a sign of increased intracranial pressure, it is not as specific as periorbital edema. A positive Kernig's sign is associated with meningitis, not increased intracranial pressure.

4. Any disease that produces ____ malabsorption can bring about deficiencies of vitamins A, D, E, and K.

• A. water
• B. protein
• C. fat
• D. carbs

Correct answer: C

Rationale: Vitamins A, D, E, and K are fat-soluble, meaning they require fat for absorption. Diseases that cause fat malabsorption can lead to deficiencies in these vitamins.

5. Which is the best description of a full-liquid diet?

• A. Most suitable for individuals with an ileostomy
• B. Suitable for individuals with lactose intolerance
• C. Contains low saturated fat and high fiber
• D. Provides adequate nutrients and is easily digested

Correct answer: D

Rationale: The correct answer is D because a full-liquid diet is designed to provide adequate nutrients while being easily digested. Choices A and B are incorrect because a full-liquid diet is not specifically tailored for individuals with an ileostomy or lactose intolerance. Choice C is also incorrect as it describes characteristics that are not defining features of a full-liquid diet.

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