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. Your alertness to both the physical and emotional needs of clients is based on which of the following philosophical frameworks?

• A. There is a basic similarity among human beings.
• B. All behavior has meaning for communicating a message or need.
• C. Human beings are systems of interdependent and interrelated parts.
• D. Each individual has the potential for growth and change in the direction of positive mental health.

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. Inadequate intake of vitamin A occurs in lower socioeconomic groups due to a lack of resources to purchase and consume vegetables and fruits.

• A. Both the statement and the reason are correct and related.
• B. Both the statement and the reason are correct but are not related.
• C. The statement is correct, but the reason is not correct.
• D. The statement is not correct, but the reason is correct.

Correct answer: A

Rationale: Both the statement and the reason are correct and related. Inadequate intake of vitamin A in lower socioeconomic groups is due to a lack of resources to purchase and consume vegetables and fruits. This is supported by the fact that the average intake in the United States meets the Recommended Dietary Allowance (RDA) for vitamin A intake, except in lower socioeconomic groups. These individuals often lack the financial means to buy, prepare, and eat a variety of fruits and vegetables, leading to deficiencies. It's important to note that because vitamin A can be stored in the liver, most adults have sufficient quantities to maintain health. Choices B, C, and D are incorrect because the statement and reason are both accurate and logically connected, as the lack of resources directly impacts the ability to obtain necessary sources of vitamin A.

4. A nurse is providing teaching about formula feeding to the parents of an infant. Which of the following instructions should the nurse include?

• A. Formula that remains in the bottle should not be used for one more feeding.
• B. Formula should be changed to whole milk when the infant is 12 months old.
• C. If the infant is gaining weight too rapidly, do not dilute the formula.
• D. If the infant turns away after taking most of the feeding, stop the feeding.

Correct answer: D

Rationale: If the infant turns away after taking most of the feeding, it indicates they are full, and continuing to feed may lead to overfeeding. Choice A is incorrect because it is not safe to use formula that remains in the bottle for another feeding due to the risk of bacterial contamination. Choice B is incorrect as whole milk should be introduced after the infant is 12 months old, not 9 months old. Choice C is incorrect as diluting formula can compromise the infant's nutrition and should not be done without healthcare provider guidance.

5. In which condition is underconsumption of fat not a concern?

• A. Malabsorption syndromes
• B. Cystic fibrosis
• C. AIDS
• D. Hypertension

Correct answer: D

Rationale: The correct answer is D, Hypertension. Hypertension is not typically associated with underconsumption of fat; instead, it is more related to the consumption of excess fat, especially saturated and trans fats, which can contribute to increased blood pressure. Malabsorption syndromes, cystic fibrosis, and AIDS are conditions where underconsumption of fat can be a concern due to various reasons such as malabsorption issues, pancreatic insufficiency, or increased energy needs.

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