Nursing Elites

1. A patient tells the nurse “I am depressed to talk to you, leave me alone” Which of the following response by the nurse is most therapeutic?

• A. I’ll be back in an hour
• B. Why are you so depressed?
• C. I’ll seat with you for a moment
• D. Call me when you feel like talking to me

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.

2. After a vaginal examination, the nurse determines that the client’s fetus is in an occiput posterior position. The nurse would anticipate that the client will have:

• A. A precipitous birth
• B. Intense back pain
• C. Frequent leg cramps
• D. Nausea and vomiting

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.

3. Which breakfast items indicate an understanding of foods high in antioxidants A and C?

• A. Fried eggs, sausage, and whole wheat toast
• B. Oatmeal with blueberries and coffee
• C. Cereal with strawberries and low-fat milk
• D. Hard-boiled eggs, cantaloupe, and orange juice

Correct answer: D

Rationale: The correct answer is D: Hard-boiled eggs, cantaloupe, and orange juice. Cantaloupe and orange juice are rich in vitamins A and C, which are known for their antioxidant properties. Choice A is incorrect because fried eggs, sausage, and whole wheat toast do not contain high levels of antioxidants A and C. Choice B is incorrect because, while blueberries are high in antioxidants, coffee does not provide significant amounts of vitamins A and C. Choice C is incorrect because, although strawberries are a good source of vitamin C, low-fat milk does not contribute significantly to vitamins A and C.

4. A nurse at a provider's office is providing teaching to a client who is taking chemotherapy and losing weight. Which of the following should the nurse recommend to increase calorie and protein intake? (Select one that does not apply.)

• A. Top yogurt with fruits.
• B. Add cream to soups.
• C. Use milk instead of water in recipes.
• D. Increase fluids during meals.

Correct answer: D

Rationale: The correct recommendation to increase calorie and protein intake for a client taking chemotherapy and losing weight is to add cream to soups (choice B), as it provides additional calories and proteins. Using milk instead of water in recipes (choice C) can also increase the calorie and protein content. Topping yogurt with fruits (choice A) can be a healthy choice but may not significantly increase calorie and protein intake. Increasing fluids during meals (choice D) may fill up the stomach, potentially reducing the intake of solid foods, which is not ideal when trying to increase calorie and protein consumption.

5. When taking a blood pressure reading, where should the cuff be positioned?

• A. The cuff should be deflated fully before immediately starting a second reading for the same patient
• B. The cuff should be deflated quickly after being inflated to 180 mmHg
• C. The cuff should be large enough to wrap around the upper arm of the adult patient, positioned 1 cm above the brachial artery
• D. The cuff should be inflated to 30 mmHg above the estimated systolic BP based on palpation of the radial or brachial artery

Correct answer: D

Rationale: When measuring blood pressure, the cuff should be inflated to 30 mmHg above the estimated systolic blood pressure based on palpation of the radial or brachial artery. This ensures an accurate blood pressure measurement. Choices A, B, and C are incorrect. Deflating the cuff fully before starting a second reading (Choice A) does not directly relate to the position of the cuff during a reading. Deflating the cuff quickly after inflating to 180 mmHg (Choice B) is not recommended because it can potentially lead to inaccurate readings. While ensuring the cuff is large enough to wrap around the upper arm positioned 1 cm above the brachial artery is important (Choice C), this alone does not guarantee an accurate blood pressure reading. The correct inflation based on palpation is the key element for accuracy, which is why Choice D is correct.

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