Nursing Elites

1. Which potential complication should the nurse assess for in the client with infective endocarditis who has embolization of vegetative lesions from the mitral valve?

• A. Pulmonary embolism
• B. Decreased urine output
• C. Hemoptysis
• D. Deep vein thrombosis

Correct answer: B

Rationale: The correct answer is 'Decreased urine output.' Embolization of vegetative lesions from the mitral valve can cause renal infarction, leading to a decrease in urine output. This complication is due to the obstruction of blood flow to the kidneys. Choices A, C, and D are incorrect because embolization from the mitral valve typically does not directly cause pulmonary embolism, hemoptysis, or deep vein thrombosis.

2. The client is diagnosed with hereditary spherocytosis. Which treatment/procedure would the nurse prepare the client to receive?

• A. Bone marrow transplant
• B. Splenectomy
• C. Frequent blood transfusions
• D. Liver biopsy

Correct answer: B

Rationale: The correct answer is B: Splenectomy. Splenectomy is the treatment of choice for hereditary spherocytosis as it helps prevent hemolysis and improve anemia. Removing the spleen reduces the destruction of the abnormal red blood cells. Choice A, Bone marrow transplant, is not a standard treatment for hereditary spherocytosis. Choice C, Frequent blood transfusions, may be used to manage anemia in some cases but is not the primary treatment for hereditary spherocytosis. Choice D, Liver biopsy, is not a treatment for hereditary spherocytosis; it is a procedure used to diagnose liver conditions, not related to this hematologic disorder.

3. The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement?

• A. Notify the healthcare provider
• B. Document that the pericarditis has resolved
• C. Ask the client to lean forward and listen again
• D. Prepare to insert a unilateral chest tube

Correct answer: C

Rationale: The correct action for the nurse to implement when unable to auscultate a pericardial friction rub in a client diagnosed with pericarditis is to ask the client to lean forward and listen again. Leaning forward can help bring the heart closer to the chest wall, making it easier to detect the rub. Option A (Notifying the healthcare provider) is incorrect because further assessment is needed before escalating the situation. Option B (Documenting that the pericarditis has resolved) is incorrect as the absence of a friction rub does not necessarily mean resolution. Option D (Preparing to insert a unilateral chest tube) is incorrect as this intervention is not indicated for the absence of a friction rub.

4. When does short-bowel syndrome usually occur?

• A. The longitudinal muscles of the intestine contract
• B. More than 50% of the small intestine is surgically removed
• C. More than 50% of the large intestine is surgically removed
• D. Transit time is decreased due to infection or drugs

Correct answer: B

Rationale: Short-bowel syndrome typically occurs when more than 50% of the small intestine is surgically removed. This condition leads to malabsorption issues due to the reduced length of the intestine for absorption. Choices A, C, and D are incorrect because short-bowel syndrome specifically relates to the insufficient length of the small intestine, not the contraction of longitudinal muscles, surgical removal of the large intestine, or decreased transit time due to infection or drugs.

5. People who use monoamine oxidase inhibitors for the treatment of depression need to avoid foods high in:

• A. Folate
• B. Tyramine
• C. Potassium
• D. Vitamin K

Correct answer: B

Rationale: The correct answer is B: Tyramine. When individuals taking monoamine oxidase inhibitors (MAOIs) consume foods high in tyramine, it can lead to a potentially dangerous increase in blood pressure known as a hypertensive crisis. Foods high in tyramine include aged cheeses, cured meats, and certain fermented foods. Choices A, C, and D are incorrect. Folate, potassium, and vitamin K are not typically contraindicated with the use of MAOIs.

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