Nursing Elites

1. You are to measure the client's initial blood pressure reading by doing all of the following EXCEPT:

• A. Take the blood pressure reading on both arms for comparison
• B. Listen to and identify the phases of Korotkoff sounds
• C. Pump the cuff to around 50 mmHg above the point where the pulse is obliterated
• D. Observe procedures for infection control

Correct answer: B

Rationale: When measuring blood pressure, it is crucial to follow specific steps to obtain accurate readings. Taking the blood pressure on both arms for comparison helps assess any variations. Pumping the cuff to around 50 mmHg above the point of pulse obliteration ensures accurate measurements. Observing procedures for infection control is vital to prevent the spread of infections. Listening to and identifying the phases of Korotkoff sounds are associated with auscultatory blood pressure measurements, not the initial blood pressure reading process.

2. How many diet-related major risk factors for coronary heart disease does Mrs. Winslow have?

• A. 1
• B. 4
• C. 2
• D. 3

Correct answer: B

Rationale: Mrs. Winslow has four major diet-related risk factors for coronary heart disease: high total cholesterol, high LDL cholesterol, high triglycerides, and low HDL cholesterol. Choice A is incorrect because there are more than one risk factor present. Choices C and D are incorrect as they do not account for the total number of diet-related major risk factors identified.

3. What is the most common nutritional disorder for the older adult?

• A. Obesity
• B. Underweight
• C. Vitamin deficiency
• D. Dehydration

Correct answer: A

Rationale: The correct answer is A: Obesity. Among older adults, obesity is the most common nutritional disorder. This is often attributed to reduced physical activity levels and changes in metabolism that occur with aging. Choice B (Underweight) is less common among older adults as compared to obesity. While choices C (Vitamin deficiency) and D (Dehydration) are important nutritional issues, they are generally not as prevalent as obesity in the older adult population.

4. A nurse is initiating continuous enteral feedings for a client who has a new gastrostomy tube. Which of the following actions should the nurse take?

• A. Measure the client’s gastric residual every 12 hours.
• B. Obtain the client’s electrolyte levels every 4 hours.
• C. Keep the client’s head elevated at 15° during feedings.
• D. Flush the client’s tube with 30 mL of water every 4 hours.

Correct answer: D

Rationale: Flushing the client’s tube with 30 mL of water every 4 hours is essential to maintain tube patency and prevent blockages. This action helps ensure the continuous flow of enteral feedings without obstruction. Measuring the client’s gastric residual every 12 hours (Choice A) is important but not the priority when initiating enteral feedings. Obtaining the client’s electrolyte levels every 4 hours (Choice B) is unnecessary and not directly related to tube feeding initiation. Keeping the client’s head elevated at 15° during feedings (Choice C) is a good practice to prevent aspiration, but tube flushing is more crucial to prevent tube occlusion.

5. Health practitioners evaluate disease progression in HIV-infected patients by measuring the concentrations of helper T cells and circulating virus, called _____.

• A. cross resistance
• B. the immune response
• C. acquired resistance
• D. the viral load

Correct answer: D

Rationale: The viral load is the measure of the amount of circulating virus in the blood and is used to evaluate the progression of HIV infection.

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