Nursing Elites

1. Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia? (Select one that does not apply)

• A. Age
• B. Blood pressure
• C. Respiratory rate
• D. Oxygen saturation

Correct answer: D

Rationale: The correct answer is 'Oxygen saturation.' When calculating the CURB-65 score for a patient with pneumonia, the factors considered include mental status (confusion), BUN (elevated), blood pressure (decreased), respiratory rate (increased), and age (65 and older). Oxygen saturation is not used in the CURB-65 scoring system. While blood pressure, respiratory rate, and age are factors that are used in the calculation of the CURB-65 score, oxygen saturation is not part of the scoring criteria. Therefore, oxygen saturation is the factor that does not apply when calculating the CURB-65 score.

2. A 45-year-old woman is prescribed ropinirole (Requip) for Parkinson's Disease. The patient is living at home with her daughter. The nurse is most concerned about which side effect of ropinirole?

• A. Slurred speech
• B. Sudden dizziness
• C. Mask-like facial expression
• D. Stooped posture

Correct answer: B

Rationale: The correct answer is 'Sudden dizziness.' Dizziness and orthostatic hypotension are serious adverse effects of ropinirole that can lead to an increased risk of falls. Ropinirole belongs to the drug class of dopamine agonists, which mimic dopamine in the brain (Parkinson's Disease is characterized by a lack of dopamine). 'Slurred speech' is not a common side effect of ropinirole. 'Mask-like facial expression' and 'Stooped posture' are more associated with the progression of Parkinson's Disease itself rather than a side effect of ropinirole.

3. The nurse is caring for a 10-year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is:

• A. Urinary output of 30 ml per hour
• B. No complaints of thirst
• C. Increased hematocrit
• D. Good skin turgor around burn

Correct answer: A

Rationale: For a child of this age, this is adequate output, yet does not suggest overload. Disruption of sodium-ATPase activity presumably causes an intracellular sodium shift which contributes to hypovolemia and cellular edema. Heat injury also initiates the release of inflammatory and vasoactive mediators. These mediators are responsible for local vasoconstriction, systemic vasodilation, and increased transcapillary permeability. Increase in transcapillary permeability results in a rapid transfer of water, inorganic solutes, and plasma proteins between the intravascular and interstitial spaces.

4. While suctioning the endotracheal tube of an adult client, what level of pressure should the nurse apply?

• A. 70-80 mmHg
• B. 100-120 mmHg
• C. 150-170 mmHg
• D. 200 mmHg

Correct answer: B

Rationale: When suctioning the endotracheal tube of an adult client, the nurse should set the suction apparatus at a level no higher than 150 mmHg, with a preferable level between 100 and 120 mmHg. Suction pressure that is too high can contribute to the client's hypoxia. Alternatively, too low suction pressure may not clear adequate amounts of secretions. Choice A (70-80 mmHg) is too low and may not effectively clear secretions. Choices C (150-170 mmHg) and D (200 mmHg) are too high and can potentially harm the client by causing hypoxia or damaging the airway.

5. When analyzing the results of the urinalysis collected preoperatively from a child with epispadias scheduled for surgical repair, which finding should the nurse most likely expect to note?

• A. Hematuria
• B. Proteinuria
• C. Bacteriuria
• D. Glucosuria

Correct answer: C

Rationale: Epispadias is a congenital defect characterized by the abnormal placement of the urethral orifice of the penis, often on the dorsum. This anatomical anomaly predisposes individuals to bacterial entry into the urinary tract, leading to bacteriuria. Hematuria, proteinuria, and glucosuria are not typically associated with epispadias. Hematuria refers to the presence of blood in the urine, proteinuria indicates protein in the urine, and glucosuria is the presence of glucose in the urine, none of which are commonly seen in epispadias.

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