Nursing Elites

1. A 21-year-old male is brought to the ED following a night of partying in his fraternity. His friends found him 'asleep' and couldn't get him to respond. They cannot recall how many alcoholic beverages he drank the night before. While educating a student nurse and the man's friends, the nurse begins by explaining that alcohol is:

• A. A water-soluble compound that is easily absorbed by the gastric lining of the stomach.
• B. Very lipid-soluble and rapidly crosses the blood–brain barrier.
• C. Able to reverse the transport of some substances to remove them from the brain.
• D. Very likely to cause sedation and therefore the client just needs to sleep it off.

Correct answer: B

Rationale: The correct answer is B. Alcohol is very lipid-soluble and rapidly crosses the blood–brain barrier, leading to its effects on the central nervous system and causing symptoms like sedation and unconsciousness. Choice A is incorrect because alcohol is not water-soluble; it is lipid-soluble. Choice C is incorrect as alcohol does not reverse the transport of substances from the brain. Choice D is incorrect as sedation from alcohol is not a reason to just 'sleep it off' in cases of alcohol poisoning, which can be life-threatening and requires medical attention.

2. When educating a patient starting on oral contraceptives, what should the nurse include in the teaching plan regarding potential side effects?

• A. Weight gain, mood changes, and nausea
• B. Increased appetite, insomnia, and fatigue
• C. Breast tenderness, headaches, and dizziness
• D. Fatigue, hair loss, and joint pain

Correct answer: A

Rationale: The correct answer is A: Weight gain, mood changes, and nausea are common side effects of oral contraceptives. Weight gain may occur due to fluid retention or changes in metabolism. Mood changes can be caused by hormonal fluctuations. Nausea is a common side effect that usually improves after a few months of use. Choices B, C, and D are incorrect because they do not reflect common side effects associated with oral contraceptives. Increased appetite, insomnia, breast tenderness, headaches, dizziness, fatigue, hair loss, and joint pain are not typically reported side effects of oral contraceptives.

3. What is a common cause of a pulmonary embolism?

• A. An autoimmune disorder
• B. A venous blood clot from the lower extremity
• C. An increase in intracranial pressure
• D. Hypotension

Correct answer: B

Rationale: A pulmonary embolism is commonly caused by a blood clot that originates in the venous system of the lower extremity and travels to the lungs, blocking blood flow. This clot is known as a venous thromboembolism. An autoimmune disorder (Choice A) is not typically associated with pulmonary embolism. Intracranial pressure (Choice C) refers to pressure inside the skull and is unrelated to pulmonary embolism. Hypotension (Choice D) is low blood pressure and is not a common cause of pulmonary embolism.

4. A 60-year-old male patient presents with severe and persistent pain in his left leg and hip that worsens with activity. After further evaluation, the patient is diagnosed with osteosarcoma. Which of the following is true about osteosarcoma?

• A. It is more common in children and young adults.
• B. Early diagnosis improves the prognosis.
• C. It is frequently located in the leg bones.
• D. All of the above are true.

Correct answer: D

Rationale: Osteosarcoma is a type of bone cancer that can be found in any bone but is most commonly located in the long bones of the legs. While it is more prevalent in children and young adults, it can also occur in older individuals like the 60-year-old male patient in this case. Early diagnosis is crucial for a better prognosis in osteosarcoma cases. Therefore, all the statements provided are true regarding osteosarcoma, making option D the correct answer. Option A is accurate as osteosarcoma is more common in children and young adults. Option B is correct as early diagnosis improves the prognosis. Option C is accurate as osteosarcoma is frequently located in the leg bones.

5. Which pathophysiologic process causes the decreased glomerular filtration rate in a patient with acute glomerulonephritis?

• A. Decreased renal-induced constriction of the renal arteries
• B. Immune complex deposition, increased capillary permeability, and cellular proliferation
• C. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial hydrostatic pressure
• D. Scar tissue formation throughout the proximal convoluted tubule secondary to toxin-induced collagen synthesis

Correct answer: B

Rationale: The correct answer is B: Immune complex deposition, increased capillary permeability, and cellular proliferation. In acute glomerulonephritis, immune complexes deposit in the glomerulus, leading to inflammation, increased capillary permeability, and cellular proliferation. These processes collectively reduce the glomerular filtration rate. Choices A, C, and D do not accurately describe the pathophysiologic process in acute glomerulonephritis. Decreased renal-induced constriction of the renal arteries, necrosis of nephrons due to increased kidney interstitial hydrostatic pressure, and scar tissue formation in the proximal convoluted tubule are not the primary mechanisms responsible for the decreased filtration rate in this condition.

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