Nursing Elites

1. 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.

2. Which organ absorbs water and vitamin K and may be affected by ulcerative colitis?

• A. Stomach
• B. Pancreas
• C. Large intestine
• D. Small intestine

Correct answer: C

Rationale: The large intestine is the organ that is primarily responsible for the absorption of water and vitamin K in the human body. A disease like ulcerative colitis can disrupt these functions by causing inflammation and ulcers in the lining of the large intestine, leading to digestive issues. The stomach (Choice A) primarily functions to break down and digest food, not to absorb water and vitamins. The pancreas (Choice B) secretes enzymes to aid in digestion and hormones to regulate blood sugar, but does not absorb water and vitamins. The small intestine (Choice D) is primarily responsible for absorbing nutrients from digested food, but not specifically water and vitamin K. Therefore, these other choices are incorrect.

3. What chronic disease has been associated with increased risks of dental problems?

• A. diabetes mellitus
• B. chronic obstructive pulmonary disease
• C. Addison's disease
• D. asthma

Correct answer: A

Rationale: Diabetes mellitus is associated with an increased risk of dental problems, including gum disease and tooth loss, due to high blood sugar levels. While chronic obstructive pulmonary disease (COPD), Addison's disease, and asthma may have oral health implications, diabetes mellitus is specifically known for its strong association with dental issues.

4. Which of the following statements about Z-Track technique is false?

• A. Z-Track injections prevent irritation of the subcutaneous tissues
• B. The technique involves creating a Zig-Zag like pattern of medication
• C. It forces the medication to be contained in the subcutaneous tissues
• D. It is used when administering Parenteral Iron

Correct answer: B

Rationale: The Z-Track technique is aimed at preventing medication leakage into the surrounding tissues by sealing the medication in the muscle, not by creating a Zig-Zag pattern. Choice A is correct as Z-Track injections help prevent irritation. Choice C is correct as it accurately describes how the technique works. Choice D is also correct as the Z-Track technique is commonly used when administering Parenteral Iron to prevent staining and irritation of the surrounding tissues.

5. A nurse is completing an admission assessment on an adolescent client who is a vegetarian. He eats milk products but does not like beans. Which of the following items should the nurse suggest the client order for lunch to provide the nutrients most likely to be lacking in his diet?

• A. Peanut butter and jelly sandwich
• B. Baked potato topped with sour cream
• C. Bagel with cream cheese
• D. Fruit salad

Correct answer: D

Rationale: The correct answer is 'Fruit salad.' Since the adolescent client is a vegetarian who eats milk products but does not like beans, suggesting a fruit salad for lunch would provide essential nutrients like vitamins, minerals, and fiber that are commonly found in fruits. Fruit salad can help supplement the nutrients that may be lacking in his diet. Choices A, B, and C do not offer the same variety and quantity of nutrients as a fruit salad, making them less optimal choices for meeting the client's dietary needs.

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