Nursing Elites

1. A healthcare professional is reading the chest x-ray report of a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. The healthcare professional interprets that the tube is positioned above:

• A. The first tracheal cartilaginous ring
• B. The point where the larynx connects to the trachea
• C. The bifurcation of the right and left main stem bronchi
• D. The area connecting the oropharynx to the laryngopharynx

Correct answer: C

Rationale: The carina is a cartilaginous ridge that separates the openings of the two main stem (right and left) bronchi. If an endotracheal tube is inserted past the carina, the tube will enter the right main stem bronchus due to the natural curvature of the airway. This positioning is dangerous as only the right lung will be ventilated. It can be identified as only the right lung will have breath sounds and rise and fall with ventilation. Choices A, B, and D are incorrect as they do not relate to the specific anatomical landmark mentioned in the scenario.

2. A client with a history of lung disease is at risk for respiratory acidosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: A

Rationale: The correct answer is A: Disorientation and dyspnea. In respiratory acidosis, the retention of carbon dioxide leads to an increase in carbonic acid, causing the pH of the blood to decrease. This can result in symptoms such as dyspnea (difficulty breathing) due to hypoxia and disorientation due to the effects of hypercapnia (elevated carbon dioxide levels) on the brain. Choice B is incorrect because while drowsiness and tachypnea can be present in respiratory acidosis, headache is not a common symptom. Choice C is incorrect because dizziness and paresthesias are not typical symptoms of respiratory acidosis. Choice D is incorrect because dysrhythmias and a decreased respiratory rate and depth are more commonly associated with respiratory alkalosis, not respiratory acidosis.

3. After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will not take this drug with food or milk.
• B. If I suspect pregnancy, I will discontinue the drug.
• C. An orange color in my urine should not alarm me.
• D. I will consume two glasses of cranberry juice daily.

Correct answer: C

Rationale: The correct answer is C. Phenazopyridine commonly discolors urine to a deep reddish orange, which can be mistaken for blood. It is important for the client to understand that this color change is an expected side effect and should not be a cause for alarm. Additionally, the urine can stain clothing. There are no dietary restrictions or precautions related to food or milk intake while taking phenazopyridine. Stopping the medication if suspecting pregnancy is not necessary as phenazopyridine is safe to use during pregnancy. Drinking cranberry juice is not directly related to the use of phenazopyridine and is not a specific instruction given for managing bacterial cystitis.

4. A client with a diagnosis of hypothermia is being admitted to the hospital by a nurse. Which of the following signs does the nurse anticipate that this client will exhibit?

• A. Increased heart rate and increased blood pressure
• B. Increased heart rate and decreased blood pressure
• C. Decreased heart rate and increased blood pressure
• D. Decreased heart rate and decreased blood pressure

Correct answer: D

Rationale: Hypothermia decreases the heart rate and blood pressure due to reduced metabolic needs of the body. With lower metabolic demands, the heart's workload decreases, leading to reductions in both heart rate and blood pressure. Choices A, B, and C are incorrect because hypothermia typically results in a decrease in heart rate and blood pressure, not an increase.

5. Which client is at greatest risk for coronary artery disease?

• A. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago.
• B. A 43-year-old male with a family history of CAD and a cholesterol level of 158 (8.8 mmol/L).
• C. A 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin.
• D. A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L).

Correct answer: D

Rationale: The 65-year-old female who is obese with a high LDL level of 188 (10.4 mmol/L) is at the greatest risk for coronary artery disease. Obesity and high LDL cholesterol levels are significant risk factors for developing coronary artery disease. While factors like mitral valve prolapse (choice A) and a family history of CAD (choice B) can contribute to the risk, they are not as significant as obesity and high LDL levels. Choice C, a 56-year-old male with high HDL and taking atorvastatin, is actually at lower risk due to the high HDL levels and being on statin therapy, which helps reduce cholesterol levels and lower the risk of coronary artery disease.

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