Nursing Elites

1. A nurse is completing an admission assessment on an adolescent client who is vegan. Which breakfast item should the nurse recommend as a protein combination with their diet restriction?

• A. Bagel with cream cheese
• B. Wheat toast with jelly
• C. Oatmeal pancakes with peanut butter
• D. Eggs with tofu bacon

Correct answer: C

Rationale: The correct answer is C: Oatmeal pancakes with peanut butter. For a vegan client, it is important to recommend plant-based protein sources. Oatmeal pancakes with peanut butter offer a good protein combination that aligns with their dietary restriction. Choices A, B, and D are not suitable as they all contain animal-derived products, which are not suitable for a vegan diet.

2. Chest x-ray was ordered after thoracentesis. When your client asks what is the reason for another chest x-ray, you will explain:

• A. to rule out pneumothorax
• B. to rule out any possible perforation
• C. to decongest
• D. to rule out any foreign body

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.

3. In persons who are obese, weight reduction can improve such CHD risk factors as hypertension, blood lipid abnormalities, and?

• A. inflammation
• B. insulin resistance
• C. gastrointestinal motility disorders
• D. damage from cigarette smoking

Correct answer: B

Rationale: Weight reduction in obese individuals can improve insulin resistance, a key factor in reducing the risk of coronary heart disease and type 2 diabetes.

4. What characterizes Obsessive Compulsive Disorder?

• A. Uncontrollable impulse to perform an act or ritual repeatedly
• B. Persistent thoughts and behavior
• C. Recurring unwanted and disturbing thoughts
• D. Pathological persistence of unwilled thoughts

Correct answer: A

Rationale: Obsessive Compulsive Disorder (OCD) is characterized by the uncontrollable impulse to perform an act or ritual repeatedly (Choice A). This is driven by recurring unwanted and disturbing thoughts (Choice C), but the distinguishing factor is the compulsive behavior, making choice A the most accurate. While choice B can be seen as true, it lacks the specific detail of the compulsive behavior that makes A a better answer. Choice D is not incorrect, but it uses terminology that is less precise and less commonly used to describe OCD, making it a less accurate choice than A. The provided rationale is not relevant to the question.

5. In monitoring the patient in PACU, the nurse correctly identifies that checking the patient's vital signs is done every:

• A. 1 hour
• B. 5 minutes
• C. 15 minutes
• D. 30 minutes

Correct answer: A

Rationale: Correct Answer: A - Vital signs monitoring in the PACU (Post-Anesthesia Care Unit) is typically done every hour to closely monitor the patient's condition during the immediate postoperative period. This frequency allows the nurse to promptly identify any changes in the patient's vital signs and intervene as necessary. Choice B (5 minutes) is too frequent for routine vital signs monitoring in the PACU and may not allow for a comprehensive assessment of the patient's stability. Choice C (15 minutes) and Choice D (30 minutes) are also not in line with the standard practice of vital signs monitoring in the PACU, which is typically hourly.

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