Nursing Elites

1. What special consideration should be taken into account when Mario prepares Richard for postural drainage and percussion?

• A. Monitoring a respiratory rate of 16 to 20 per minute
• B. Assessing the client's ability to tolerate sitting and lying positions
• C. Ensuring the client is free of signs of infection
• D. Knowing the time of the client's last food and fluid intake

Correct answer: A

Rationale: The correct answer is A, 'Monitoring a respiratory rate of 16 to 20 per minute'. When performing postural drainage and percussion, it is crucial to monitor the respiratory rate to ensure the safety and effectiveness of the procedure. Choice B, 'Assessing the client's ability to tolerate sitting and lying positions', while important, is not directly related to the specifics of postural drainage and percussion. Similarly, option C, 'Ensuring the client is free of signs of infection', although important, is not directly linked to the procedure. Option D, 'Knowing the time of the client's last food and fluid intake', might be relevant for other procedures, but it is not the primary consideration for postural drainage and percussion.

2. What intervention would be most appropriate for a patient who has difficulty eating because of chewing problems?

• A. Use squeeze bottles to pour liquids into the mouth
• B. Provide utensils that have modified handles
• C. Offer plates with food guards
• D. Provide soft foods

Correct answer: D

Rationale: Providing soft foods is crucial for patients with chewing difficulties to ensure they can consume adequate nutrition without discomfort.

3. A healthcare provider is teaching a client who has constipation about a high-fiber diet. Which of the following foods should be included as sources of fiber? (Select one that does not apply.)

• A. Whole wheat bread
• B. Kidney beans
• C. Refined cereals
• D. Blackberries

Correct answer: C

Rationale: Refined cereals are not a good source of fiber as they have been processed and stripped off most of their fiber content. Whole wheat bread, kidney beans, and blackberries are excellent sources of fiber. Whole wheat bread is made from whole grains, which are high in fiber. Kidney beans are rich in fiber and can help alleviate constipation. Blackberries are a good source of fiber and can aid in promoting bowel regularity.

4. The nurse notes that the fall might also cause a possible head injury. The patient will be observed for signs of increased intracranial pressure which include:

• A. Narrowing of the pulse pressure
• B. Vomiting
• C. Periorbital edema
• D. A positive Kernig's sign

Correct answer: C

Rationale: Periorbital edema is a sign of increased intracranial pressure. It is caused by fluid accumulation around the eyes due to compromised drainage. Narrowing of the pulse pressure is more indicative of shock than increased intracranial pressure. While vomiting can be a sign of increased intracranial pressure, it is not as specific as periorbital edema. A positive Kernig's sign is associated with meningitis, not increased intracranial pressure.

5. A nurse is educating the parent of a preschool-age child about nutrition. Which is the best snack choice for the nurse to recommend to the parent?

• A. Fruit snacks
• B. Mini wheat bagel with peanut butter
• C. White toast with jelly
• D. Sports drink

Correct answer: B

Rationale: The best snack choice for a preschool-age child recommended by the nurse would be a mini wheat bagel with peanut butter. This option provides a good balance of carbohydrates, protein, and healthy fats, making it a more nutritious choice compared to the other options. Fruit snacks may contain added sugars and lack essential nutrients. White toast with jelly is high in simple carbohydrates and sugars, providing less sustained energy. Sports drinks are often high in sugar and not necessary for a preschool-age child's snack.

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