Nursing Elites

1. A client with a history of smoking presents with a chronic cough and shortness of breath. The nurse should suspect which condition?

• A. Pulmonary fibrosis
• B. Chronic obstructive pulmonary disease (COPD)
• C. Lung cancer
• D. Pulmonary edema

Correct answer: B

Rationale: The correct answer is B: Chronic obstructive pulmonary disease (COPD). COPD is often associated with a chronic cough and shortness of breath, especially in individuals with a history of smoking. Pulmonary fibrosis (choice A) typically presents with progressive dyspnea and dry cough. Lung cancer (choice C) may present with a chronic cough, shortness of breath, and other symptoms like weight loss and hemoptysis. Pulmonary edema (choice D) presents with symptoms such as acute shortness of breath, orthopnea, and pink, frothy sputum.

2. A patient is prescribed medroxyprogesterone acetate (Provera) for the treatment of endometriosis. What key instruction should the nurse provide regarding the administration of this medication?

• A. Take the medication at the same time each day to maintain consistent hormone levels.
• B. Discontinue the medication if side effects occur.
• C. Take the medication with food to prevent gastrointestinal upset.
• D. Apply the medication once a week.

Correct answer: A

Rationale: The correct instruction for medroxyprogesterone acetate (Provera) is to take the medication at the same time each day to maintain consistent hormone levels and ensure its effectiveness. Choice B is incorrect because discontinuing the medication abruptly without consulting healthcare providers can be harmful. Choice C is incorrect as taking the medication with food is not necessary for this specific drug. Choice D is incorrect as medroxyprogesterone is typically taken orally, not applied topically.

3. In a 70-year-old man with a history of chronic obstructive pulmonary disease (COPD) reporting increasing shortness of breath, wheezing, and cough, which finding would indicate a potential exacerbation of his COPD?

• A. Increased wheezing
• B. Decreased respiratory rate
• C. Improved exercise tolerance
• D. Decreased sputum production

Correct answer: A

Rationale: The correct answer is A: Increased wheezing. In COPD exacerbations, there is a worsening of symptoms such as increased wheezing due to airway inflammation and narrowing. Choices B, C, and D are incorrect. Decreased respiratory rate would not be expected in COPD exacerbation as it is usually a compensatory mechanism to maintain oxygenation. Improved exercise tolerance is not a typical finding in exacerbations but rather a sign of improvement. Decreased sputum production is also not indicative of exacerbation, as exacerbations are often associated with increased sputum production.

4. Which of the following is a factor that leads to increased risk for dehydration in the elderly?

• A. More insensible losses
• B. Increase in muscle mass
• C. Decline in kidney function
• D. Decrease in fat

Correct answer: Decline in kidney function

Rationale: The correct answer is C: Decline in kidney function. As people age, their kidneys may not work as effectively in conserving water and concentrating urine, leading to a higher risk of dehydration. Choice A is incorrect because more insensible losses do not directly relate to an increased risk of dehydration in the elderly. Choice B, an increase in muscle mass, is not a factor that leads to dehydration. Choice D, a decrease in fat, is also not a direct factor contributing to dehydration in the elderly.

5. Which disorder is caused by a Staphylococcus aureus organism producing a toxin leading to exfoliation and large blister formation?

• A. Herpes simplex I virus
• B. Bullous impetigo
• C. Necrotizing fasciitis
• D. Cellulitis

Correct answer: B

Rationale: Bullous impetigo is the correct answer because it is caused by a Staphylococcus aureus toxin that leads to exfoliation and the formation of large blisters. Herpes simplex I virus (Choice A) causes cold sores and is not associated with exfoliation and blister formation. Necrotizing fasciitis (Choice C) is a severe skin infection involving the deeper layers of skin and subcutaneous tissues, typically caused by bacteria such as Streptococcus or Clostridium species, not Staphylococcus aureus. Cellulitis (Choice D) is a common bacterial skin infection, but it does not involve exfoliation and blister formation as seen in bullous impetigo.

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