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. A patient following a vegetarian diet might be at risk for deficiency in which nutrient?

• A. Vitamin C
• B. Vitamin B12
• C. Vitamin A
• D. Vitamin D

Correct answer: B

Rationale: Vitamin B12 is primarily found in animal products, so vegetarians may need supplementation.

3. Which of the following interventions should be considered the highest priority when caring for June, who has hemiparesis secondary to a stroke?

• A. Position June in an upright lateral position
• B. Perform range of motion exercises
• C. Apply antiembolic stockings
• D. Use hand rolls or pillows for support

Correct answer: C

Rationale: The correct answer is C, 'Apply antiembolic stockings'. In the case of a patient who has experienced a stroke and is suffering from hemiparesis, the highest priority intervention is to prevent further complications such as deep vein thrombosis (DVT), which can be life-threatening. Antiembolic stockings are used to increase venous blood flow velocity and reduce the risk of DVT. Choice 'A', positioning June in an upright lateral position, while important for overall care, is not the highest priority. Choice 'B', performing range of motion exercises, is an important part of recovery but not the immediate priority. Choice 'D', using hand rolls or pillows for support, is also a valuable intervention but does not address the most pressing risk of further complications.

4. During the detoxification stage, it is a priority for the nurse to:

• A. teach skills to recognize and respond to health threatening situations
• B. increase the client’s awareness of unsatisfactory protective behaviors
• C. implement behavior modification
• D. promote homeostasis and minimize the client’s withdrawal symptoms

Correct answer: A

Rationale: Patient safety and efficacy of care depend on actions rooted in established nursing protocols that consider both the immediate and long-term needs of the patient.

5. What are the responsibilities of a nurse towards a patient?

• A. A registered nurse is responsible for a group of patients from their admission to their discharge
• B. A registered nurse only provides care for the patient with the assistance of nursing aides
• C. A nurse's only responsibility is to perform administrative duties in a healthcare setting
• D. A nurse's only responsibility is to maintain hospital equipment

Correct answer: A

Rationale: A registered nurse is responsible for a group of patients from their admission to their discharge. This responsibility encompasses assessing patient needs, formulating care plans, administering medications, monitoring patient progress, and coordinating with other members of the healthcare team. Choice B is not entirely accurate because, even though nurses often work with nursing aides, the nurses themselves hold the ultimate responsibility for the overall care of the patient. Choices C and D are incorrect as they depict an incomplete and inaccurate representation of a nurse's role, which extends beyond administrative duties and equipment maintenance to primarily focus on direct patient care.

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