Nursing Elites

1. A client with cystic fibrosis is admitted with a pulmonary exacerbation. Which intervention should the nurse prioritize?

• A. Administer a high-calorie, high-protein diet.
• B. Initiate airway clearance techniques.
• C. Encourage the client to maintain an active lifestyle.
• D. Monitor for signs of respiratory distress.

Correct answer: B

Rationale: During a pulmonary exacerbation in cystic fibrosis, the priority intervention is to initiate airway clearance techniques. These techniques help clear mucus from the airways, improving ventilation and reducing the risk of respiratory complications. Administering a high-calorie, high-protein diet is beneficial for overall nutrition but is not the priority during an exacerbation. Encouraging an active lifestyle is important for long-term health but does not address the immediate need for managing exacerbations. Monitoring for signs of respiratory distress is important, but initiating airway clearance techniques takes precedence in the management of pulmonary exacerbations in cystic fibrosis.

2. Inflammatory exudates are a combination of several types. Which of the following exudates is composed of a large accumulation of leukocytes?

• A. Serous
• B. Purulent
• C. Fibrinous
• D. Hemorrhagic

Correct answer: B

Rationale: The correct answer is B: Purulent. Purulent exudates, or pus, consist primarily of leukocytes and dead cells, indicating a bacterial infection. Serous exudates contain a thin, watery fluid with few leukocytes. Fibrinous exudates are rich in fibrin and are commonly seen in severe inflammation. Hemorrhagic exudates contain red blood cells due to blood vessel damage.

3. A 5-month-old child is admitted to the hospital with recurring respiratory infections. A possible cause of this condition is:

• A. Hypergammaglobulinemia
• B. Increased maternal IgG
• C. Immune insufficiency
• D. Decreased maternal antibody breakdown, resulting in hyposensitivity

Correct answer: C

Rationale: Immune insufficiency is a possible cause of recurring respiratory infections in a 5-month-old child. In this scenario, the child's immune system may not be functioning optimally, leading to a susceptibility to infections. Choices A, B, and D are incorrect. Hypergammaglobulinemia refers to high levels of gamma globulins in the blood and is not typically associated with recurring respiratory infections in this context. Increased maternal IgG would provide passive immunity to the child, offering some protection against infections. Decreased maternal antibody breakdown leading to hyposensitivity is not a common cause of recurring respiratory infections in a 5-month-old child.

4. A woman is being treated with clomiphene citrate for the treatment of infertility. She states to the nurse that she has seen an increase in vaginal discharge. The nurse knows that this effect is related to:

• A. Increased blood flow to the vaginal area.
• B. Increased cervical mucus production.
• C. Increased production of vaginal secretions.
• D. Increased lubrication in the vaginal canal.

Correct answer: C

Rationale: The correct answer is C: 'Increased production of vaginal secretions.' Clomiphene citrate affects cervical mucus production, leading to an increase in vaginal secretions. This effect is beneficial for fertility as it helps create a more hospitable environment for sperm transport. Choice A, 'Increased blood flow to the vaginal area,' is incorrect as the increase in vaginal discharge is primarily due to changes in cervical mucus. Choice B, 'Increased cervical mucus production,' is partially correct but does not fully explain the increase in vaginal secretions. Choice D, 'Increased lubrication in the vaginal canal,' is not directly related to the effect seen with clomiphene citrate treatment for infertility.

5. What critical point should the nurse include in patient education regarding tamoxifen (Nolvadex) for a patient with breast cancer?

• A. Tamoxifen may increase the risk of venous thromboembolism.
• B. Tamoxifen may cause hot flashes and other menopausal symptoms.
• C. Tamoxifen may cause weight gain and fluid retention.
• D. Tamoxifen may decrease the risk of osteoporosis.

Correct answer: A

Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism. Patients should be educated about the signs and symptoms of blood clots, such as swelling, redness, and pain in the legs. Choices B, C, and D are incorrect because tamoxifen is not associated with causing hot flashes, weight gain, fluid retention, or decreasing the risk of osteoporosis.

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