Nursing Elites

1. A client is brought to the emergency department after a motor vehicle accident in which she suffered a spinal cord injury at the level of C5. Which of the following assessments should be the priority?

• A. Monitoring urinary output
• B. Monitoring heart rate and rhythm
• C. Monitoring respiratory rate
• D. Monitoring the client's pain levels

Correct answer: B

Rationale: The correct answer is monitoring heart rate and rhythm. With a C5 spinal cord injury, monitoring heart rate and rhythm is crucial as it can impact autonomic regulation. This level of injury can affect cardiac function due to the disruption of sympathetic nerve fibers. Monitoring urinary output may be important to assess for urinary retention, but it is not the priority in this scenario. While monitoring respiratory rate is essential in all patients, in this case, cardiovascular stability takes precedence. Pain management is important but is not the priority when assessing a client with a C5 spinal cord injury.

2. A nurse is teaching a young adult patient about oral contraceptives, which the patient will soon begin taking. The patient's primary concern is the effectiveness of the medication in preventing pregnancy. The nurse should teach the patient that oral contraceptives, when taken consistently, are how effective in preventing pregnancy?

• A. Between 96% and 98%
• B. Approximately 98.5%
• C. Highly effective, but partially dependent on genetic factors
• D. Nearly 100%

Correct answer: D

Rationale: When taken correctly, estrogen–progestin contraceptive preparations are nearly 100% effective in preventing pregnancy. Choices A, B, and C are incorrect. Choice A suggests a range below the actual effectiveness, choice B provides a specific percentage that is not accurate, and choice C introduces the concept of genetic factors which is not relevant to the effectiveness of oral contraceptives.

3. What condition can be caused by an excessive amount of growth hormone released by the pituitary gland in childhood?

• A. Acromegaly
• B. Gigantism
• C. Syndrome of inappropriate antidiuretic hormone
• D. Dwarfism

Correct answer: B

Rationale: Gigantism is the correct answer. It is a condition caused by excessive growth hormone release before the epiphyseal plates close, leading to abnormal growth. Acromegaly (choice A) is caused by excess growth hormone after the epiphyseal plates close, resulting in enlargement of bones and tissues. Syndrome of inappropriate antidiuretic hormone (choice C) is characterized by the excessive release of antidiuretic hormone, leading to water retention and dilutional hyponatremia. Dwarfism (choice D) is a condition characterized by significantly below-average height.

4. A patient with benign prostatic hyperplasia (BPH) is prescribed finasteride (Proscar). What outcome should the nurse expect if the medication is effective?

• A. Decreased urinary frequency and urgency
• B. Increased prostate size
• C. Increased blood pressure
• D. Decreased blood pressure

Correct answer: A

Rationale: The correct answer is A: Decreased urinary frequency and urgency. Finasteride is used to reduce the size of the prostate gland in patients with BPH. As a result, when the medication is effective, the patient should experience a decrease in urinary frequency and urgency. Choices B, C, and D are incorrect. Choice B is inaccurate because finasteride aims to reduce prostate size, not increase it. Choices C and D are unrelated to the action of finasteride in treating BPH.

5. 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.

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