Nursing Elites

1. The GAUGE size in ET tubes determines:

• A. The external circumference of the tube
• B. The internal diameter of the tube
• C. The length of the tube
• D. The tube’s volumetric capacity

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.

2. A nearby community provides blood pressure screening, height and weight measurement, smoking cessation classes and aerobics class services. This type of program is referred to as

• A. outreach program
• B. hospital extension program
• C. barangay health program
• D. wellness program

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.

3. While evaluating the meal choices of a client with major depressive disorder and a prescription of Phenelzine, which of the following selections should the nurse identify as appropriate?

• A. Cheddar cheese
• B. Smoked salmon
• C. Strawberry yogurt
• D. Pepperoni pizza

Correct answer: C

Rationale: The correct answer is C, 'Strawberry yogurt.' This choice is appropriate because it does not contain high levels of tyramine, which can lead to a dangerous interaction with Phenelzine, a monoamine oxidase inhibitor. Tyramine-rich foods, like aged cheeses (such as cheddar cheese) and cured meats (like smoked salmon and pepperoni), should be avoided by individuals taking Phenelzine to prevent hypertensive crisis. Strawberry yogurt is a safer option for the client in this scenario.

4. What happens when Mrs. Guevarra, a nurse, delegates aspects of the client's care to the nurse-aide, an unlicensed staff member?

• A. Mrs. Guevarra makes the assignment to instruct the staff member
• B. Mrs. Guevarra is assigning the responsibility to the aide but not the accountability for those tasks
• C. Mrs. Guevarra does not need to directly supervise or evaluate the aide
• D. Mrs. Guevarra must know how to perform the task being delegated

Correct answer: C

Rationale: The correct answer is C. While it is true that Mrs. Guevarra is delegating tasks to the nurse-aide, she does not necessarily have to directly supervise or evaluate the aide. She still retains the overall accountability for the care of the client, but direct supervision of the aide is not a requirement for delegation. Choice A is incorrect because the primary purpose of delegation is not instruction. Choice B is also incorrect because although Mrs. Guevarra is delegating tasks, she still retains accountability for those tasks. Finally, choice D is incorrect because the ability to perform the task being delegated is not a requirement for the delegator; the delegatee should have the necessary skills and knowledge to perform the delegated tasks.

5. Water loss can occur from each, except one. Which is the exception?

• A. Respiratory inflammation
• B. Strenuous exercise
• C. Diarrhea
• D. Perspiration

Correct answer: D

Rationale: The correct answer is D, Perspiration. Water loss can occur through respiration inflammation, strenuous exercise, and diarrhea. Perspiration, also known as sweating, is a mechanism by which the body regulates temperature and eliminates some waste products, but it is not a cause of water loss. The body loses water through sweating, but this loss is mainly for cooling purposes, and it is not a primary mechanism for water loss like respiration, exercise, or diarrhea.

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