Nursing Elites

1. A client is being prepared for placement of a catheter for total parenteral nutrition. Which of the following access sites should be planned for catheter insertion?

• A. Left antecubital vein
• B. Right subclavian vein
• C. Right femoral artery
• D. Left arm radial artery

Correct answer: B

Rationale: The correct answer is the Right subclavian vein. When preparing a client for placement of a catheter for total parenteral nutrition, the preferred access site for catheter insertion is the subclavian vein due to its large size, central location, and lower risk of infection compared to peripheral veins. The other options provided (Left antecubital vein, Right femoral artery, and Left arm radial artery) are not suitable access sites for central venous catheter insertion for total parenteral nutrition.

2. Medication for treating high blood cholesterol levels should not be used for most people unless:

• A. The patient has at least three major risk factors for coronary heart disease
• B. The patient has been experiencing symptoms of coronary heart disease for at least three months
• C. The patient's medical insurance covers prescription drugs
• D. Treatment with Therapeutic Lifestyle Changes (TLC) alone is unsuccessful after three months

Correct answer: D

Rationale: The correct answer is choice D because medication for high cholesterol is typically not considered unless Therapeutic Lifestyle Changes (TLC), which include diet and exercise, have not proven effective after a three-month period. This approach ensures that lifestyle modifications are given a fair chance to lower cholesterol levels before resorting to medication. Choice A is incorrect because the number of risk factors for coronary heart disease does not dictate when to begin medication; it is about the effectiveness of lifestyle changes. Choice B is incorrect as the duration of coronary heart disease symptoms does not determine when to start medication; the focus is on the response to TLC. Choice C is incorrect because the coverage of prescription drugs by the patient's insurance does not influence the medical decision to use medication for high cholesterol; it is based on medical necessity and effectiveness of prior interventions.

3. Inadequate intake of vitamin A occurs in lower socioeconomic groups due to a lack of resources to purchase and consume vegetables and fruits.

• A. Both the statement and the reason are correct and related.
• B. Both the statement and the reason are correct but are not related.
• C. The statement is correct, but the reason is not correct.
• D. The statement is not correct, but the reason is correct.

Correct answer: A

Rationale: Both the statement and the reason are correct and related. Inadequate intake of vitamin A in lower socioeconomic groups is due to a lack of resources to purchase and consume vegetables and fruits. This is supported by the fact that the average intake in the United States meets the Recommended Dietary Allowance (RDA) for vitamin A intake, except in lower socioeconomic groups. These individuals often lack the financial means to buy, prepare, and eat a variety of fruits and vegetables, leading to deficiencies. It's important to note that because vitamin A can be stored in the liver, most adults have sufficient quantities to maintain health. Choices B, C, and D are incorrect because the statement and reason are both accurate and logically connected, as the lack of resources directly impacts the ability to obtain necessary sources of vitamin A.

4. Because of increasing cases of fluorosis, low levels of fluoride are added to commercial infant formula. Breast milk provides low levels of fluoride.

• A. Both statements are true
• B. Both statements are false
• C. The first statement is true; the second is false
• D. The first statement is false; the second is true

Correct answer: D

Rationale: The first statement is false; fluoride is not added to infant formulas due to the risk of fluorosis. The second statement is true; breast milk contains low levels of fluoride.

5. Mrs. Pichay who is for thoracentesis is assigned by the nurse to any of the following positions, EXCEPT:

• A. straddling a chair with arms and head resting on the back of the chair
• B. lying on the unaffected side with the bed elevated 30-40 degrees
• C. lying prone with the head of the bed lowered 15-30 degrees
• D. sitting on the edge of the bed with her feet supported and arms and head on a padded overhead table

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.

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