Nursing Elites

1. During the acute phase of a burn, the priority nursing intervention in caring for this client is:

• A. Prevention of infection
• B. Pain management
• C. Prevention of bleeding
• D. Fluid resuscitation

Correct answer: D

Rationale: During the acute phase of a burn, fluid resuscitation is the priority nursing intervention. This phase is characterized by fluid loss and the risk of hypovolemic shock. Administering fluids is crucial to maintain perfusion and prevent complications such as organ failure. While prevention of infection, pain management, and prevention of bleeding are important aspects of burn care, fluid resuscitation takes precedence in the acute phase to stabilize the client's condition and prevent further damage.

2. A client who is postpartum and has been diagnosed with iron deficiency anemia should be taught to consume which of the following dietary recommendations?

• A. Yogurt and mozzarella
• B. Spinach and beef
• C. Milk and turkey slices
• D. Fish and cottage cheese

Correct answer: C

Rationale: The correct answer is spinach and beef. Both spinach and beef are high in iron, making them excellent choices to help combat iron deficiency anemia. Yogurt, mozzarella, milk, turkey slices, fish, and cottage cheese are not as rich in iron compared to spinach and beef, so they are not the most suitable dietary recommendations for a client with iron deficiency anemia.

3. In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within:

• A. 24 hours
• B. 36 hours
• C. 48 hours
• D. 12 hours

Correct answer: B

Rationale: In an extreme situation where no other resident or intern is available, if a nurse receives telephone orders, the order has to be correctly written and signed by the physician within 36 hours. This time frame ensures timely documentation and validation of the orders. Choice A (24 hours) is too short a period for busy physicians to fulfill the task. Choice C (48 hours) is too long and delays the incorporation of physician orders into the patient's care plan. Choice D (12 hours) may not provide enough time for the physician to review and sign the order, especially in situations where immediate attention is not required.

4. A nurse is teaching a client about strategies to prevent constipation. Which of the following statements by the client indicates an understanding of the teaching?

• A. Drinking four to five glasses of water per day will prevent constipation.
• B. I should consume mineral oil once per day.
• C. Eating foods high in fiber will make elimination easier.
• D. I can skip a meal if I feel bloated.

Correct answer: C

Rationale: The correct answer is C. Eating foods high in fiber increases stool bulk and promotes easier elimination, thus preventing constipation. Choices A, B, and D are incorrect. Drinking water is important, but the emphasis should be on high-fiber foods. Mineral oil is not a recommended first-line treatment for constipation, and skipping meals can disrupt regular bowel movements, potentially leading to constipation.

5. Mang Carlos has a standing DNR order. He then suddenly stopped breathing and you are at his bedside. You would:

• A. Give extraordinary measures to save Mang Carlos
• B. Stay with Mang Carlos and Do nothing
• C. Call the physician
• D. Activate Code Blue

Correct answer: B

Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.

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