Nursing Elites

1. What nursing diagnosis would be most appropriate for a patient with heart failure?

• A. risk for infection
• B. fluid volume excess
• C. impaired body temperature
• D. ineffective airway clearance

Correct answer: B

Rationale: The most appropriate nursing diagnosis for a patient with heart failure is 'fluid volume excess.' In heart failure, the heart's reduced pumping ability leads to fluid retention, causing an excess of fluid in the body. This can result in symptoms such as edema, shortness of breath, and weight gain. 'Risk for infection,' 'impaired body temperature,' and 'ineffective airway clearance' are not the most appropriate nursing diagnoses for a patient with heart failure as they do not directly relate to the pathophysiology and common issues seen in heart failure patients.

2. Persons experiencing crisis becomes passive and submissive. As a nurse, you know that the best approach in crisis intervention is to be:

• A. Active and Directive
• B. Passive friendliness
• C. Active friendliness
• D. Firm kindness

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.

3. A nurse is caring for a client who is lactose intolerant. Which of the following clinical manifestations should the nurse assess?

• A. Fever
• B. Blood in stools
• C. Cramping
• D. Steatorrhea

Correct answer: C

Rationale: The correct answer is C: Cramping. Cramping is a common clinical manifestation of lactose intolerance due to the inability to digest lactose properly. Fever (choice A) is not typically associated with lactose intolerance. Blood in stools (choice B) is more indicative of other gastrointestinal issues like inflammatory bowel disease. Steatorrhea (choice D) is the presence of excess fat in the stool and is not a typical symptom of lactose intolerance.

4. _____ neutralizes stomach acid in the small intestine:

• A. saliva
• B. gastric mucus
• C. bicarbonate ions
• D. enzymes

Correct answer: C

Rationale: The correct answer is C: bicarbonate ions. Bicarbonate ions, secreted by the pancreas, neutralize the acidic chyme entering the small intestine from the stomach, creating a more suitable environment for digestive enzymes. Saliva (choice A) helps in the initial breakdown of food in the mouth, not in neutralizing stomach acid. Gastric mucus (choice B) protects the stomach lining from the acidic environment but does not neutralize the acid in the small intestine. Enzymes (choice D) facilitate chemical reactions in digestion but do not neutralize stomach acid.

5. Sickle cell disease is an example of an inherited mistake in the amino acid sequence.

• A. TRUE
• B. FALSE
• C.
• D.

Correct answer: A

Rationale: The statement is TRUE. Sickle cell disease is caused by a genetic mutation in the hemoglobin gene, leading to an abnormal amino acid sequence. This results in the production of abnormal hemoglobin molecules, causing red blood cells to become sickle-shaped. This inherited condition is a classic example of a genetic error affecting the amino acid sequence, making choice A the correct answer. Choices B, C, and D are incorrect as they do not accurately reflect the nature of sickle cell disease.

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