Nursing Elites

1. A client has acute dysphagia. Which of the following nursing interventions should be included in the plan of care?

• A. Providing a straw for consumption of liquids
• B. Encouraging larger bites
• C. Placing the client in semi-Fowler's position during meals
• D. Instructing the client to tilt head forward when swallowing

Correct answer: C

Rationale: Placing the client in semi-Fowler's position during meals is the correct intervention for a client with acute dysphagia. This position helps prevent aspiration by facilitating swallowing. Providing a straw for consumption of liquids (Choice A) can increase the risk of aspiration and is not recommended for clients with dysphagia. Encouraging larger bites (Choice B) can also increase the risk of choking and aspiration. Instructing the client to tilt the head forward when swallowing (Choice D) is not the recommended technique for managing dysphagia as it does not address the underlying issue effectively.

2. What is a common symptom of vitamin D deficiency?

• A. Hair loss
• B. Night blindness
• C. Bone pain
• D. Rashes

Correct answer: C

Rationale: The correct answer is C: Bone pain. Vitamin D deficiency often leads to bone pain and weakness as it plays a crucial role in maintaining bone health by aiding in the absorption of calcium. Hair loss (choice A) is not a common symptom of vitamin D deficiency. Night blindness (choice B) is typically associated with vitamin A deficiency, not vitamin D deficiency. Rashes (choice D) are not a common symptom of vitamin D deficiency.

3. Which nursing diagnosis is a priority for clients with Borderline personality disorder?

• A. Risk for injury
• B. Ineffective individual coping
• C. Altered thought process
• D. Sensory perceptual alteration

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.

4. A nurse is instructing a group of clients about nutrition. The nurse should include that which of the following foods is a good source of high-quality protein?

• A. Soybeans
• B. Grains
• C. Legumes
• D. Green vegetables

Correct answer: A

Rationale: Soybeans are a good source of high-quality protein. They contain all the essential amino acids needed by the body. Grains, legumes, and green vegetables do not provide as much high-quality protein as soybeans. Grains and legumes are good sources of protein but may lack some essential amino acids, while green vegetables generally have lower protein content compared to soybeans.

5. After bronchoscopy, the nurse's priority is to check which of the following before feeding?

• A. Gag reflex
• B. Wearing off of anesthesia
• C. Swallowing reflex
• D. Peristalsis

Correct answer: A

Rationale: After a bronchoscopy procedure, the nurse's priority is to check the patient's gag reflex before allowing them to eat to prevent aspiration. The gag reflex helps protect the airway by triggering a cough or gag response if something touches the back of the throat. This is crucial to ensure that the patient can protect their airway and prevent food or fluids from entering the lungs, especially when the throat may be sensitive or compromised post-bronchoscopy. Checking for the wearing off of anesthesia, swallowing reflex, or peristalsis are important assessments but not the immediate priority before feeding in this context.

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