Nursing Elites

1. The nurse knows that after receiving the blood from the blood bank, it should be administered within:

• A. 1 hour
• B. 2 hours
• C. 4 hours
• D. 6 hours

Correct answer: D

Rationale: Blood transfusions need to be administered promptly after receiving the blood from the blood bank to ensure patient safety and effectiveness. Waiting too long can lead to complications such as bacterial growth in the blood product, which can be harmful when infused. Administering the blood within 6 hours is crucial to prevent such risks. Choices A, B, and C are incorrect because waiting for 1, 2, or 4 hours respectively can increase the likelihood of complications associated with delayed transfusion.

2. A nurse is assessing the nutritional status of an infant who is 6 months old. The infant weighed 2.7 kg at birth. Which of the following indicates to the nurse that the infant is within the expected range?

• A. 5.5 kg
• B. 6.4 kg
• C. 4.5 kg
• D. 3.6 kg

Correct answer: B

Rationale: The correct answer is B, 6.4 kg. An infant's weight should approximately double by 6 months. In this case, starting from a birth weight of 2.7 kg, a weight of 6.4 kg at 6 months indicates normal growth. Choice A (5.5 kg) is below the expected range for a 6-month-old infant. Choices C (4.5 kg) and D (3.6 kg) are also below the expected weight gain, indicating inadequate growth.

3. The nurse is caring for a client taking warfarin. Which meal brought in by the client's family is a priority to remove before the client eats it?

• A. Oriental cabbage salad with chicken
• B. Beef enchilada, rice, and beans
• C. Ham and cheese sandwich
• D. Macaroni salad and grapefruit slices

Correct answer: C

Rationale: The correct answer is C. Ham is high in vitamin K, which can interfere with warfarin. Vitamin K can decrease the effectiveness of warfarin, an anticoagulant medication. Choices A, B, and D do not contain high levels of vitamin K and are less likely to interfere with the client's warfarin therapy.

4. Ms. ANA had a car accident where he lost her boyfriend. As a result, she became passive and submissive. The nurse knows that the type of crisis Ms. ANA is experiencing is:

• A. Developmental crisis
• B. Maturational crisis
• C. Situational crisis
• D. Social Crisis

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.

5. A patient is being cared for by a nurse who has stomatitis following radiation treatment. Which of the following is an appropriate intervention for the nurse to take?

• A. Serve foods without sauces or gravies
• B. Offer mouth rinses with normal saline and water
• C. Serve foods while still at a hot temperature
• D. Instruct the client to drink liquids without a straw

Correct answer: B

Rationale: Offering mouth rinses with normal saline and water is an appropriate intervention for a nurse caring for a patient with stomatitis following radiation treatment. This intervention can help soothe and clean the mouth, promoting comfort and oral hygiene. Choice A is incorrect because serving foods without sauces or gravies does not directly address the client's stomatitis. Choice C is incorrect because serving hot foods can exacerbate discomfort in the client's mouth. Choice D is incorrect because using a straw can help in preventing further irritation in the client's mouth.

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