Nursing Elites

1. A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication?

• A. Weight gain of 5 pounds
• B. Edema of the ankles
• C. Gastric irritability
• D. Decreased appetite

Correct answer: D

Rationale: The correct answer is 'Decreased appetite.' Furosemide is a loop diuretic used for conditions like heart failure, where it helps reduce fluid retention. One common side effect of furosemide is hypokalemia, which can lead to decreased appetite among other symptoms. Hypokalemia is a low level of potassium in the blood, and its signs and symptoms include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias, reduced urine osmolality, and altered level of consciousness. Weight gain and ankle edema are actually expected outcomes of furosemide therapy due to its diuretic effect, which helps reduce edema and fluid overload. Gastric irritability is a nonspecific symptom that is not typically associated with furosemide use. Therefore, a decreased appetite is a key indicator of a potential negative side effect when assessing a client on furosemide therapy.

2. Clinical manifestations of asthma include:

• A. Decreased expiratory time
• B. Increased peak expiratory flow
• C. Increased use of accessory muscles
• D. Increased oxygen saturation

Correct answer: C

Rationale: Clinical manifestations of asthma include increased use of accessory muscles, increased expiratory time, increased peak expiratory flow, and decreased oxygen saturation. Choice A, 'Decreased expiratory time,' is incorrect because asthma typically presents with increased expiratory time due to airway obstruction. Choice B, 'Increased peak expiratory flow,' is incorrect as asthma commonly leads to decreased peak expiratory flow due to airway constriction. Choice D, 'Increased oxygen saturation,' is incorrect because asthma exacerbations often result in decreased oxygen saturation levels.

3. The major difference between a grand mal and petit mal seizure is that a person with a grand mal seizure will have _______________ and the person with a petit mal seizure will not.

• A. convulsive movements
• B. sleep apnea
• C. atonic movements
• D. flaccidity

Correct answer: A

Rationale: The major difference between a grand mal and petit mal seizure is the presence or absence of convulsive movements. Grand mal seizures are characterized by convulsive movements, including jerking of limbs and loss of consciousness. In contrast, petit mal seizures, also known as absence seizures, typically involve brief episodes of staring or eye blinking without convulsive movements. Therefore, choice A, 'convulsive movements,' is the correct answer. Choices B, 'sleep apnea,' and D, 'flaccidity,' are incorrect as they are not associated with the characteristics of grand mal or petit mal seizures. Choice C, 'atonic movements,' is also incorrect as petit mal seizures do not involve atonic movements, but rather absence behaviors such as staring spells.

4. Why should a 30-year-old Caucasian woman who works the night shift take Vitamin D supplements?

• A. It's a standard part of the overall nutritional treatment for the prevention of osteomalacia.
• B. It helps your intestines absorb calcium, which is important for bone formation.
• C. It stimulates skin cells to produce calcium, which is then released into the bloodstream to be used for bone formation.
• D. Vitamin D supplements should not be taken by someone of your age.

Correct answer: B

Rationale: The correct answer is B: 'It helps your intestines absorb calcium, which is important for bone formation.' Vitamin D plays a crucial role in aiding the absorption of calcium from the intestines into the bloodstream, which is essential for bone health and formation. Choice A is incorrect because it does not specifically address the role of Vitamin D in calcium absorption. Choice C is incorrect as Vitamin D does not stimulate skin cells to produce calcium; rather, it helps regulate calcium levels in the body. Choice D is incorrect as age alone is not a contraindication for Vitamin D supplementation; the need for supplementation is based on individual health status and risk factors.

5. The parents of a newborn have been told that their child was born with bladder exstrophy, and the parents ask the nurse about this condition. Which explanation, given by the parents, indicates understanding of this condition?

• A. ''It's a hereditary disorder that occurs in every other generation.''
• B. ''It is caused by the use of medications taken by the mother during pregnancy.''
• C. ''It is a condition in which the urinary bladder is abnormally located in the pelvic cavity.''
• D. ''It's an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall.''

Correct answer: D

Rationale: Bladder exstrophy is a congenital anomaly characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause of bladder exstrophy is not precisely known, but it is believed to be due to a developmental abnormality during embryogenesis. The condition is more common in male newborns. Choice A is incorrect as bladder exstrophy is not a hereditary disorder that occurs in every other generation. Choice B is incorrect as bladder exstrophy is not caused by medications taken by the mother during pregnancy. Choice C is incorrect as it describes the condition inaccurately; it is not just an abnormal location of the bladder in the pelvic cavity, but rather an extrusion of the bladder outside the body through a defect in the lower abdominal wall.

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