Nursing Elites

1. For an incontinent elderly client who frequently wets his bed and develops redness and skin excoriation at the perianal area, what is the best nursing goal?

• A. Ensure that the bed linen is always dry
• B. Frequently check the bed for wetness and keep it dry
• C. Place a rubber sheet under the client's buttocks
• D. Keep the patient clean and dry

Correct answer: A

Rationale: The best nursing goal for an incontinent elderly client with skin excoriation is to ensure that the bed linen is always dry. This helps in preventing further skin breakdown and promoting skin integrity. Choice B, to frequently check the bed for wetness and keep it dry, may not address the issue of prevention if the linen is not consistently dry. Choice C, placing a rubber sheet under the client's buttocks, focuses more on protecting the mattress rather than addressing the client's skin condition directly. Choice D, keeping the patient clean and dry, is important but does not specifically address the preventive aspect of maintaining dry bed linen.

2. Each of the following accurately describes aspects of the dietary reference intakes (DRIs) published by the Food and Nutrition Board of the Institute of Medicine (IOM) except one. Which one is the exception?

• A. The DRIs replace the older recommended daily allowances
• B. Current DRIs attempt to estimate required nutrients to improve long-term health
• C. DRIs specifically address individuals whose requirements are affected by a disease state
• D. The DRIs attempt to establish maximum safe levels of tolerance for nutrients

Correct answer: C

Rationale: The correct answer is C. DRIs are intended for the general population and do not specifically address disease states, which are managed with different clinical guidelines. Choice A is correct as DRIs have replaced the older recommended daily allowances. Choice B is correct as current DRIs aim to estimate the required nutrients for long-term health. Choice D is correct as DRIs also attempt to establish maximum safe levels of tolerance for nutrients.

3. Which nutrient deficiency are people who regularly take prescription drugs such as steroids and diuretics at risk for?

• A. Potassium
• B. Selenium
• C. Iodine
• D. Chloride

Correct answer: A

Rationale: Regular intake of prescription drugs like steroids and diuretics can lead to the loss of potassium in the body, causing a condition known as hypokalemia. Therefore, people on these medications require careful monitoring and often need potassium supplementation to prevent this deficiency. The other options, selenium, iodine, and chloride, are incorrect because there is no specific link between their deficiency and the regular use of steroids and diuretics.

4. In taking the client’s blood pressure, the nurse should position the client’s arm:

• A. At the level of the heart
• B. Slightly above the level of the heart
• C. At the 5th intercostals space midclavicular line
• D. Below the level of the heart

Correct answer: A

Rationale: Proper patient positioning is essential for maximizing lung expansion and promoting the drainage of secretions. Postural drainage techniques rely on gravity to help clear different lung segments, which is critical in preventing complications such as atelectasis or pneumonia in immobilized patients.

5. Which of the following statements are correct?

• A. Lipids are transported in the blood as lipoproteins, which are clusters of lipids associated with proteins.
• B. In type II diabetes, the pancreas produces insulin, but cells are resistant to this signal.
• C. The glycemic index classifies foods based on their potential to raise blood glucose levels.
• D. All of the above

Correct answer: D

Rationale: Option A is correct because lipoproteins indeed transport lipids in the blood. They are complexes of lipids and proteins that transport water-insoluble lipids through the blood. Option B is correct as it accurately describes the condition of type II diabetes where the pancreas can produce insulin, but the cells are resistant to its signal, causing an ineffective regulation of blood sugar. Option C is also correct because the glycemic index is indeed a classification system for foods based on their potential to raise blood glucose levels. High glycemic index foods raise blood glucose levels faster than low glycemic index foods. Hence, all the statements are correct, making option D the correct answer.

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