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. Which vitamin deficiency is most likely to cause bleeding disorders?

• A. Vitamin A
• B. Vitamin E
• C. Vitamin K
• D. Vitamin D

Correct answer: C

Rationale: Vitamin K is essential for blood clotting as it plays a crucial role in the activation of clotting factors. Deficiency of Vitamin K can lead to impaired blood clotting, resulting in bleeding disorders. Vitamin A is more associated with vision and skin health, not blood clotting. Vitamin E is known for its antioxidant properties and role in immune function, not specifically related to bleeding disorders. Vitamin D plays a key role in calcium absorption and bone health, but it is not directly linked to blood clotting or bleeding disorders.

3. Has Healthy People (HP 2020), issued by the U.S. Department of Health and Human Services, resulted in a reduction of deaths from cardiovascular disease, stroke, and some cancers, as well as decreased dental caries in children aged 2 to 4 years and adults aged 53 to 44 years?

• A. Yes, both statements are true.
• B. No, both statements are false.
• C. The first statement is true; the second is false.
• D. The first statement is false; the second is true.

Correct answer: B

Rationale: Both statements are false. While Healthy People (HP 2020) has contributed to a reduction in deaths from cardiovascular disease, stroke, and some cancers, it did not result in decreased dental caries in children aged 2 to 4 years and adults aged 53 to 44 years. Therefore, the correct answer is B. Choice A is incorrect because the second statement is false. Choice C is incorrect as the first statement is also false. Choice D is incorrect as the second statement is false.

4. For an incontinent elderly client who frequently wets his bed and develops redness and skin excoriation at the perianal area, what is the best nursing goal?

• A. Ensure that the bed linen is always dry
• B. Frequently check the bed for wetness and keep it dry
• C. Place a rubber sheet under the client's buttocks
• D. Keep the patient clean and dry

Correct answer: A

Rationale: The best nursing goal for an incontinent elderly client with skin excoriation is to ensure that the bed linen is always dry. This helps in preventing further skin breakdown and promoting skin integrity. Choice B, to frequently check the bed for wetness and keep it dry, may not address the issue of prevention if the linen is not consistently dry. Choice C, placing a rubber sheet under the client's buttocks, focuses more on protecting the mattress rather than addressing the client's skin condition directly. Choice D, keeping the patient clean and dry, is important but does not specifically address the preventive aspect of maintaining dry bed linen.

5. Each statement is true of proteins, except one. Which is the exception?

• A. Proteins are composed of building blocks called amino acids
• B. The classification of the 20 common amino acids is based on the properties of their side chains
• C. The general structure of an amino acid varies considerably
• D. Amino acids polymerize to form long chains called polypeptides

Correct answer: B

Rationale: The correct answer is B. The classification of the 20 common amino acids is not based on the properties of their side chains, but rather on the structure of their amino and carboxyl groups. These groups are consistent among all amino acids, while the side chains, also known as R groups, are what vary and give each amino acid its unique properties. Choice A is correct because proteins are indeed composed of amino acids. Choice C is incorrect because while the side chains of amino acids can vary, the general structure of an amino acid - a central carbon atom bonded to an amino group, a carboxyl group, a hydrogen atom, and a side chain - is consistent. Choice D is correct because amino acids do polymerize to form long chains called polypeptides, which can then fold into complex shapes to form proteins.

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