Nursing Elites

1. A client with heart failure is experiencing pulmonary edema. Which intervention should be prioritized?

• A. Administer diuretics to reduce fluid overload.
• B. Position the client in high-Fowler's position.
• C. Administer oxygen therapy to improve oxygenation.
• D. Restrict fluid intake to prevent further fluid overload.

Correct answer: C

Rationale: In a client experiencing pulmonary edema due to heart failure, the priority intervention is to administer oxygen therapy to improve oxygenation. This helps in increasing the oxygen levels in the blood, thereby improving tissue perfusion and reducing the workload on the heart. Positioning the client in high-Fowler's position can also aid in improving oxygenation, but administering oxygen therapy directly addresses the immediate need for increased oxygen levels. Administering diuretics to reduce fluid overload and restricting fluid intake are important interventions in heart failure management, but in the acute situation of pulmonary edema, oxygen therapy takes precedence to ensure adequate oxygen supply to vital organs.

2. A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?

• A. Merkel cell
• B. Schwann cell
• C. Reed-Sternberg cell
• D. Kupffer cell

Correct answer: C

Rationale: Reed-Sternberg cells are characteristic of Hodgkin lymphoma. These large abnormal cells have a bi-lobed or multi-lobed nucleus and are essential for diagnosing Hodgkin lymphoma through histological examination. Merkel cells are associated with Merkel cell carcinoma, Schwann cells are related to nerve sheaths, and Kupffer cells are liver macrophages. Therefore, choices A, B, and D are incorrect for Hodgkin lymphoma.

3. A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand?

• A. Eosinophils
• B. Neutrophils
• C. Leukotrienes
• D. Monocytes

Correct answer: B

Rationale: Neutrophils are the first responders to bacterial infections. When there is a breach in the skin like in this scenario, neutrophils are quickly recruited to the site of injury to phagocytize and kill bacteria. Eosinophils are primarily involved in parasitic infections and allergic reactions, making choice A incorrect. Leukotrienes are lipid mediators involved in inflammation but are not cells, so choice C is incorrect. Monocytes are precursors to macrophages and play a role in immune response, but they are not the first cells to arrive at the site of a bacterial infection, making choice D incorrect.

4. A 51-year-old woman has the following clinical findings: thin hair, exophthalmos, hyperreflexia, and pretibial edema. These findings are consistent with:

• A. Subacute thyroiditis.
• B. Autoimmune thyroiditis.
• C. Graves disease.
• D. Hashimoto’s disease.

Correct answer: C

Rationale: The clinical findings of thin hair, exophthalmos, hyperreflexia, and pretibial edema are classic features of Graves disease, an autoimmune disorder that results in hyperthyroidism. Exophthalmos (bulging eyes) and pretibial edema (swelling in the lower legs) are particularly associated with Graves disease due to the autoimmune stimulation of the thyroid gland, leading to increased thyroid hormone production. Subacute thyroiditis (Choice A) typically presents with neck pain and tenderness, while autoimmune thyroiditis (Choice B) is commonly known as Hashimoto's thyroiditis, which presents with hypothyroidism symptoms. Hashimoto's disease (Choice D) is characterized by goiter and hypothyroidism, which contrasts with the hyperthyroidism seen in this patient.

5. A patient is being treated for a severe fungal infection with amphotericin B. What is the expected length of treatment for this patient?

• A. 1 to 2 weeks
• B. 3 to 6 weeks
• C. 4 to 12 weeks
• D. 15 to 18 weeks

Correct answer: C

Rationale: The correct answer is C: '4 to 12 weeks.' Amphotericin B treatment duration for severe fungal infections typically ranges from 4 to 12 weeks. This extended period is necessary to ensure complete eradication of the fungal infection and prevent relapse. Choices A, B, and D provide durations that are either too short or too long for treating severe fungal infections effectively, making them incorrect.

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