Nursing Elites

1. A 65-year-old man is admitted to the intensive care unit from the operating room after a triple coronary artery bypass graft. He is intubated and on a ventilator. Lactic acid levels were normal postoperatively, but now they are rising. The increased level could be an indication of:

• A. excessive sedation
• B. bowel ischemia
• C. excessive volume infusion in the operating room
• D. mild hypothermia postoperatively

Correct answer: B

Rationale: In this scenario, the rising lactic acid levels in a 65-year-old man after a coronary artery bypass graft could indicate bowel ischemia. Bowel ischemia can lead to anaerobic metabolism, causing an increase in lactic acid levels. Excessive sedation may cause respiratory depression but would not directly lead to rising lactic acid levels. Excessive volume infusion in the operating room might cause fluid overload but would not typically result in rising lactic acid levels. Mild hypothermia postoperatively could lead to shivering and increased oxygen consumption, but it is less likely to be the primary cause of rising lactic acid levels in this context.

2. A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the client that the venous blood supply to the penis is controlled by:

• A. Sympathetic nerves.
• B. Parasympathetic nerves.
• C. Somatic nerves.
• D. Spinal reflexes.

Correct answer: B

Rationale: Erectile function is primarily controlled by the parasympathetic nervous system, which facilitates the dilation of blood vessels in the penis. The parasympathetic nerves are responsible for vasodilation in the penis, allowing blood to enter and creating an erection. Sympathetic nerves, on the other hand, are responsible for ejaculation by causing contraction of the muscles around the vas deferens. Somatic nerves are involved in sensation and movement, not specifically in controlling blood supply to the penis. Spinal reflexes can play a role in the erectile process, but they are not directly responsible for controlling the venous blood supply.

3. A client with a history of smoking presents with a chronic cough and shortness of breath. The nurse should suspect which condition?

• A. Pulmonary fibrosis
• B. Chronic obstructive pulmonary disease (COPD)
• C. Lung cancer
• D. Pulmonary edema

Correct answer: B

Rationale: The correct answer is B: Chronic obstructive pulmonary disease (COPD). COPD is often associated with a chronic cough and shortness of breath, especially in individuals with a history of smoking. Pulmonary fibrosis (choice A) typically presents with progressive dyspnea and dry cough. Lung cancer (choice C) may present with a chronic cough, shortness of breath, and other symptoms like weight loss and hemoptysis. Pulmonary edema (choice D) presents with symptoms such as acute shortness of breath, orthopnea, and pink, frothy sputum.

4. Which of the following is a cause of edema?

• A. Decreased plasma proteins
• B. Hypotension
• C. Dehydration
• D. Polyuria

Correct answer: A

Rationale: The correct answer is A: Decreased plasma proteins. Edema can be caused by decreased plasma proteins, which reduce the osmotic pressure that keeps fluid in the blood vessels. Hypotension (choice B) is low blood pressure and is not a direct cause of edema. Dehydration (choice C) involves a lack of body fluid, but it is not a direct cause of edema. Polyuria (choice D) is excessive urination and not a direct cause of edema.

5. A person is given an attenuated antigen as a vaccine. When the person asks what was given in the vaccine, how should the nurse respond? The antigen is:

• A. Alive, but less infectious
• B. Mutated, but highly infectious
• C. Normal, but not infectious
• D. Inactive, but infectious

Correct answer: A

Rationale: An attenuated antigen used in a vaccine is alive but less infectious, aiming to stimulate an immune response. Choice B is incorrect because an attenuated antigen is not highly infectious. Choice C is incorrect as the antigen is intentionally altered to be less infectious. Choice D is incorrect as an attenuated antigen is not infectious.

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