Nursing Elites

1. A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely contributing to her complaint?

• A. Somatic pain resulting from pressure on the parietal peritoneum
• B. Referred pain from her small bowel
• C. Visceral pain resulting from distension and ischemia
• D. Neuropathic pain resulting from autonomic dysfunction

Correct answer: C

Rationale: Visceral pain is associated with distension, ischemia, and inflammation of internal organs. In the case of a small bowel obstruction, the intense, diffuse pain reported by the client is likely due to the distension and ischemia of the small bowel. Somatic pain (Choice A) would be more localized and sharp, typically arising from the parietal peritoneum. Referred pain (Choice B) is pain perceived at a site distant from the actual pathology. Neuropathic pain (Choice D) involves dysfunction or damage to the nervous system and is not typically associated with the described physiologic phenomenon of distension and ischemia in the context of a small bowel obstruction.

2. As you are walking in the park, a huge black Labrador runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpitations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by:

• A. cerebral cortex.
• B. somatic nervous system.
• C. limbic system.
• D. autonomic nervous system.

Correct answer: D

Rationale: The autonomic nervous system controls involuntary bodily functions like heart rate, respiration, and sweating. In the given scenario, the 'fight or flight' response is activated, leading to increased heart rate, palpitations, anxiety, and shaky hands. The cerebral cortex is involved in conscious thought processes and decision-making, not the immediate physiological response observed here. The somatic nervous system regulates voluntary movements, while the limbic system is responsible for emotions and memory, but the autonomic nervous system is primarily responsible for the physiological responses seen in this situation.

3. The registered nurse is teaching a class on inflammation and explains that which cell is the predominant phagocyte arriving early at inflammatory and infection sites?

• A. Macrophages
• B. Mast cells
• C. Monocytes
• D. Neutrophils

Correct answer: D

Rationale: Neutrophils are the correct answer as they are the predominant phagocytes arriving early at inflammatory and infection sites. Neutrophils are part of the body's innate immune system and are among the first responders to sites of inflammation or infection. They play a crucial role in engulfing and destroying pathogens. Macrophages, although important phagocytes, usually arrive later at the site. Mast cells are involved in allergic reactions and not primarily phagocytes. Monocytes are precursors to macrophages and are not the predominant phagocytes arriving early at inflammatory sites.

4. A patient arrives at her follow-up appointment 1 month post-hysterectomy and complains to the nurse that her scars do not seem to be healing properly. Upon inspection, the nurse notices that the scars are raised but still within the boundaries of the original incisions. The nurse tells the patient this kind of dysfunctional wound healing is called:

• A. Hypertrophic scarring
• B. Dehiscence
• C. Contracture
• D. A keloid

Correct answer: A

Rationale: Hypertrophic scarring occurs when a scar is raised but remains within the boundaries of the original wound, unlike keloids, which extend beyond the wound edges. Dehiscence refers to the separation of wound edges, while contracture involves the tightening or constriction of a scar, leading to limited mobility.

5. A patient is prescribed tadalafil (Cialis) for erectile dysfunction. What critical contraindication should the nurse discuss with the patient?

• A. Use of nitrates
• B. Use of antihypertensive medications
• C. History of hypertension
• D. History of peptic ulcer disease

Correct answer: A

Rationale: The correct answer is A: Use of nitrates. Tadalafil (Cialis) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates potentiate the hypotensive effects of tadalafil, leading to a potentially life-threatening drop in blood pressure. Choices B, C, and D are incorrect because antihypertensive medications, history of hypertension, and history of peptic ulcer disease are not critical contraindications for tadalafil use. While caution may be needed in patients with certain conditions, the highest priority is addressing the interaction with nitrates.

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