Nursing Elites

1. Mario listens to Richard’s bilateral sounds and finds that congestion is in the upper lobes of the lungs. The appropriate position to drain the anterior and posterior apical segments of the lungs when Mario does percussion would be:

• A. Client lying on his back then flat on his abdomen on Trendelenburg position
• B. Client seated upright in bed or on a chair then leaning forward in sitting position then flat on his back and on his
• C. Client lying flat on his back and then flat on his abdomen
• D. Client lying on his right then left side on Trendelenburg position

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.

2. All of the following are seen in a child with measles. Which one is not?

• A. Reddened eyes
• B. Coryza
• C. Pustule
• D. Cough

Correct answer: C

Rationale: Measles typically presents with symptoms like reddened eyes, coryza (inflammation of the mucous membrane in the nose), and cough. However, pustules are not a common symptom of measles. Pustules are more characteristic of conditions like chickenpox rather than measles. Understanding these distinctions is crucial for accurate diagnosis and appropriate treatment.

3. The parent of a child newly diagnosed with lactose intolerance is being taught by the nurse. Which food items identified by the parent indicate an understanding of foods to avoid?

• A. Popcorn, seeds, and any foods containing nuts.
• B. Milk, cheese, ice cream, and puddings.
• C. Wheat, rye, barley, and commercially baked goods.
• D. Eggs, ham, bacon, and canned meats.

Correct answer: B

Rationale: The correct answer is B. Milk, cheese, ice cream, and puddings contain lactose, which individuals with lactose intolerance should avoid. Choices A, C, and D do not contain lactose and are not typically problematic for individuals with lactose intolerance.

4. Where should a nurse auscultate the apex beat?

• A. At the fifth intercostal space, along the midclavicular line
• B. At the mid-sternum
• C. 2 inches to the left of the lower end of the sternum
• D. 1 inch to the left of the xiphoid process

Correct answer: A

Rationale: The correct location to auscultate the apex beat is at the fifth intercostal space, along the midclavicular line. This is where the apical impulse, also known as the point of maximal impulse (PMI), can be best heard. Choices B, C, and D are incorrect anatomical locations for auscultating the apex beat, which makes them incorrect choices. Auscultating at the correct location allows healthcare providers to assess the heart's function and detect any abnormalities in heart sounds, which is crucial for comprehensive patient care.

5. What is a disadvantage of using a food frequency questionnaire?

• A. It does not influence the food choices of the consumer
• B. It is not affected by seasonal changes in the diet
• C. It is not effective for monitoring short-term changes in food intake
• D. It does not take too long to obtain the results

Correct answer: C

Rationale: Option C is correct because a food frequency questionnaire is designed to capture a person's typical food intake over an extended period and is not suitable for monitoring short-term changes in diet. The questionnaire's purpose is to provide insights into long-term dietary patterns rather than immediate changes. Option A is incorrect as the questionnaire does not influence food choices; it merely records them. Option B is also incorrect because, while seasonal changes can impact food availability and thereby influence diet, the questionnaire itself is not affected by these changes. Lastly, option D is incorrect as the time to obtain results from a food frequency questionnaire would depend on the respondent's speed and accuracy rather than being intrinsically linked to the questionnaire.

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