Nursing Elites

1. A client was involved in a motor vehicle accident in which the seat belt was not worn. The client is exhibiting crepitus, decreased breath sounds on the left, complains of shortness of breath, and has a respiratory rate of 34/min. Which of the following assessment findings should concern the nurse the most?

• A. temperature of 102�F and a productive cough
• B. arterial blood gases (ABGs) with a PaO2 of 92 mmHg and PaCO2 of 40 mmHg
• C. trachea deviating to the right
• D. barrel-chested appearance

Correct answer: C

Rationale: The correct answer is 'trachea deviating to the right.' A mediastinal shift is indicative of a tension pneumothorax, which is a dangerous complication seen in trauma patients with symptoms like crepitus, decreased breath sounds, shortness of breath, and tachypnea. Assessing for acute traumatic injuries is crucial in this context. Choice A, a temperature of 102�F and a productive cough, is common in pneumonia cases and not as concerning as a mediastinal shift. Choice B, ABGs with a PaO2 of 92 mmHg and PaCO2 of 40 mmHg, shows values within normal limits and does not suggest a tension pneumothorax. Choice D, a barrel-chested appearance, is typical of COPD and not directly related to the acute traumatic injury described. A tension pneumothorax is a medical emergency where air cannot escape the pleural cavity, leading to lung collapse and a mediastinal shift to the unaffected side with a downward displacement of the diaphragm.

2. Which system is primarily affected by tuberculosis (Mycobacterium)?

• A. stomach (GI)
• B. heart (cardiac)
• C. lungs (respiratory)
• D. skin (integumentary)

Correct answer: C

Rationale: Tuberculosis, caused by Mycobacterium tuberculosis, primarily affects the respiratory system. This aerobic bacillus thrives in highly oxygenated body sites, such as the lungs, growing ends of bones, and the brain. The bacillus is airborne, making the lungs a common site for infection. Choices A, B, and D are incorrect as tuberculosis predominantly impacts the respiratory system and rarely involves the stomach, heart, or skin.

3. In alcoholics with anemia:

• A. Pernicious anemia is more common than folic acid deficiency.
• B. Iron deficiency and folic acid deficiency can coexist.
• C. The alcohol interferes with iron absorption.
• D. Oral vitamin replacement is contraindicated.

Correct answer: B

Rationale: In alcoholics with anemia, iron deficiency and folic acid deficiency can coexist due to poor dietary intake and malabsorption issues associated with chronic alcohol consumption. Pernicious anemia, primarily related to vitamin B12 deficiency, is not commonly seen in alcoholics. While alcohol can interfere with iron absorption, it is not the sole factor contributing to anemia in alcoholics. Oral vitamin replacement is not contraindicated in alcoholics with anemia; however, it may be less effective due to absorption issues related to alcohol consumption.

4. The client asked about the role of leptin in the body. Which response should the nurse provide?

• A. It increases food intake in clients, thereby promoting obesity.
• B. It assists in the regulation of steroids.
• C. It increases the total fat mass of people who are obese.
• D. It might decrease the total fat mass in the bodies of people who are obese.

Correct answer: D

Rationale: Leptin is a protein hormone expressed in fat cells that regulates fat cell percentage in the body. It is associated with increased energy expenditure and decreased food intake through hypothalamic control. In obese individuals, there may be insensitivity or resistance to leptin's effects. Leptin influences other hormones like insulin and genetic factors related to fat regulation. Therefore, the correct response is that leptin might decrease total fat mass in obese individuals as it is involved in energy balance and fat regulation. Choices A, B, and C are incorrect because leptin does not increase food intake or promote obesity; it does not assist in the regulation of steroids, and it does not increase total fat mass in people who are obese.

5. Why is starting a low CHO diet a contraindication for a client with renal insufficiency?

• A. As long as the client eats a minimum of 30g of CHO/day, there should be no problem.
• B. The client's clinical condition is a contraindication to starting a low CHO diet.
• C. Calcium supplements should be utilized to prevent the development of osteoporosis while on a low CHO diet.
• D. As long as the client eats foods that are high biologic protein sources, a low CHO diet can be followed.

Correct answer: B

Rationale: A client with renal insufficiency should not start a low CHO diet because it could result in an increased renal solute load. Clients with renal or liver disease require protein control in their diet to prevent complications. Proteins used must be of high biologic value, and protein intake is usually weight-based. Protein levels may be adjusted based on the client's clinical condition. A minimum level of carbohydrates is needed in the diet to spare protein. Vitamin and mineral supplements might be needed for clients with liver failure. The dietician plays a crucial role in calculating specific nutrient requirements for these clients and monitoring outcomes in conjunction with the healthcare team. Choice A is incorrect because simply consuming a minimum amount of carbohydrates does not address the issue of increased renal solute load. Choice C is incorrect as calcium supplements are not the primary concern when considering a low CHO diet for a client with renal insufficiency. Choice D is incorrect as the focus should be on the contraindication of a low CHO diet for a client with renal insufficiency rather than just high biologic protein sources.

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