Nursing Elites

1. Instruction on health promotion regarding urinary elimination is important. Which would you include?

• A. Hold urine as long as possible before emptying the bladder to strengthen the sphincter muscles
• B. If a burning sensation is experienced while voiding, drink water
• C. After urination, wipe from the anal area towards the pubis
• D. Tell the client to empty the bladder at each voiding

Correct answer: D

Rationale: The correct answer is to instruct the client to empty the bladder at each voiding. This is essential to prevent urinary retention and reduce the risk of urinary tract infections. Choice A is incorrect because holding urine for prolonged periods can lead to urinary retention and increase the risk of infections. Choice B is incorrect as pineapple juice can exacerbate a burning sensation due to its acidity; the correct approach is to drink water to dilute the urine. Choice C is incorrect as wiping from the anal area towards the pubis can introduce bacteria into the urinary tract, potentially causing infections.

2. Weight loss therapies that rely on juicing typically provide increased fiber, vitamins, and minerals. As an added incentive, juices contain a lower concentration of sugar than the whole fruit. Are these statements true or false?

• 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: B

Rationale: The correct answer is both statements are false. The process of juicing often extracts the liquid components of fruits and vegetables, leaving behind the fiber-rich pulp. Therefore, juicing does not typically provide increased fiber. Additionally, juices can contain a higher concentration of sugar than whole fruits because the fiber, which helps to slow down the absorption of sugar, has been removed. This can lead to a spike in blood sugar levels after consumption. The other options are incorrect because they contain at least one false statement.

3. Which type of assessment evaluates a person's risk of malnutrition by ranking key variables from the medical history and physical examination?

• A. Katz index
• B. integrated assessment
• C. subjective global assessment
• D. nutrition care plan

Correct answer: C

Rationale: The Subjective Global Assessment (SGA) is the correct choice. SGA is a comprehensive tool used to assess an individual's risk of malnutrition by integrating key variables from the medical history, physical examination, and other relevant factors. The Katz index is used to assess activities of daily living, not malnutrition risk. An integrated assessment refers to the overall evaluation process involving multiple assessments. A nutrition care plan is a personalized plan developed based on assessment findings, not the assessment itself.

4. During the Emergent phase of a burn, the most fatal electrolyte imbalance in a burned client is:

• A. Hypokalemia
• B. Hyperkalemia
• C. Hypernatremia
• D. Hyponatremia

Correct answer: A

Rationale: During the Emergent phase of burns, the most fatal electrolyte imbalance is Hypokalemia. This is due to the shift of potassium from the intracellular space to the extracellular space, leading to low potassium levels in the blood. Choices B, C, and D are incorrect because Hyperkalemia, Hypernatremia, and Hyponatremia are not typically associated with the Emergent phase of burns and do not pose the same level of risk as Hypokalemia in this context.

5. When observing a return demonstration of a colostomy irrigation, you know that more teaching is required if pt:

• A. Lubricates the tip of the catheter prior to inserting into the stoma
• B. Hangs the irrigating bag on the bathroom door cloth hook during fluid insertion
• C. Discontinues the insertion of fluid after only 500 ml of fluid has been instilled
• D. Clamps of the flow of fluid when felling uncomfortable

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.

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