Nursing Elites

1. A one-month-old infant in the neonatal intensive care unit is dying. The parents request that the nurse administer an opioid analgesic to their infant, who is crying weakly. The infant's heart rate is 68 beats per minute, and the respiratory rate is 18 breaths per minute. The infant is on room air, and the oxygen saturation is 92%. The nurse's response is based on which of the following principles?

• A. Providing analgesia during the last days and hours is an ethically appropriate nursing action.
• B. Withholding the opioid analgesia during the last days and hours is an ethical duty because administering it would represent assisted suicide.
• C. Administering analgesia during the last days and hours is the parents' ethical decision.
• D. Withholding the opioid analgesia is clinically appropriate because it will hasten the infant's death.

Correct answer: A

Rationale: All patients, regardless of age, have the right to die with dignity and be free from pain. In this case, the parents' request for an opioid analgesic to relieve the child's distress aligns with the principles of palliative care and ensuring comfort. Assisted suicide involves a conscious decision by the individual, which is not applicable to a 1-month-old infant. Both the nurse and the parents have an ethical duty to ensure the infant's comfort and well-being. Withholding opioid analgesia solely to hasten death is not appropriate, as providing pain relief is a crucial aspect of end-of-life care. Opioids can be administered to dying patients at any age to alleviate suffering without the intention of hastening death. Therefore, providing analgesia during the last days and hours is an ethically appropriate nursing action. Choices B, C, and D are incorrect because the decision to administer analgesia in this scenario is based on the best interest and comfort of the infant, not concerns about assisted suicide or hastening death. The ethical consideration is to provide compassionate care and alleviate suffering.

2. A client complaining of chest pain is prescribed an intravenous infusion of nitroglycerin (Nitro-Bid). After the infusion is initiated, the occurrence of which symptom warrants the nurse discontinuing an intravenous infusion of nitroglycerin?

• A. Frontal headache
• B. Orthostatic hypotension
• C. Decrease in intensity of chest pain
• D. Cool clammy skin

Correct answer: D

Rationale: The correct answer is 'Cool clammy skin.' This assessment finding indicates decreased cardiac output that could result from excessive vasodilation. Cool clammy skin is a sign of poor perfusion, suggesting that the blood pressure might be dropping too low. Discontinuing the nitroglycerin infusion is crucial to prevent further complications. Choice A, 'Frontal headache,' is a common side effect of nitroglycerin but not a reason to discontinue the infusion unless severe or persistent. Choice B, 'Orthostatic hypotension,' may occur as a side effect of nitroglycerin but does not necessarily warrant discontinuation unless severe. Choice C, 'Decrease in intensity of chest pain,' is actually an expected therapeutic response to nitroglycerin and indicates improved myocardial perfusion, so it is not a reason to stop the infusion.

3. Which of the following organs of the digestive system has a primary function of absorption?

• A. stomach
• B. pancreas
• C. small intestine
• D. gallbladder

Correct answer: C

Rationale: The small intestine is the correct answer. It is the primary organ responsible for absorption in the digestive system. The stomach's primary function is to break down food through mechanical and chemical digestion. The pancreas produces digestive enzymes to aid in the breakdown of food. The gallbladder stores bile produced by the liver, which helps in the digestion of fats. However, neither the stomach, pancreas, nor gallbladder play the primary role of absorption in the digestive process, making them incorrect choices.

4. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How might bacterial glycocalyx contribute to this?

• A. It protects the bacteria from antibiotic and immunologic destruction.
• B. Glycocalyx neutralizes the antibiotic, rendering it ineffective.
• C. It competes with the antibiotic for binding sites on the microbe.
• D. Glycocalyx provides nutrients for microbial growth.

Correct answer: A

Rationale: Bacterial glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes. It plays a significant role in protecting bacteria by enhancing adherence to surfaces, resisting phagocytic engulfment by white blood cells, and preventing antibiotics from contacting the microbe. Choice A is correct because glycocalyx shields the bacteria from both antibiotics and the immune system, allowing the infection to persist. Choices B, C, and D are incorrect because glycocalyx does not neutralize antibiotics, compete for binding sites with antibiotics, or provide nutrients for microbial growth.

5. What happens if folic acid is administered to treat anemia without determining its underlying cause?

• A. Erythropoiesis is inhibited
• B. Excessive levels of folic acid might accumulate, causing toxicity
• C. The symptoms of pernicious anemia might be masked, delaying treatment
• D. Intrinsic factor is destroyed

Correct answer: C

Rationale: When folic acid is given without determining the underlying cause of anemia, the symptoms of pernicious anemia may be masked, potentially delaying the correct treatment. Folic acid alone does not protect against the central nervous system changes seen in pernicious anemia, which are related to Vitamin B12 deficiency. Folic acid and Vitamin B12 are both crucial for cell growth and division. Administering folic acid without knowing the specific type of anemia could lead to a delay in addressing the root cause. Option A is incorrect because folic acid is essential for erythropoiesis, the production of red blood cells. Option B is incorrect as excessive folic acid can cause toxicity, but it is not the primary concern in this context. Option D is incorrect because folic acid treatment for anemia does not directly impact intrinsic factor, which is related to Vitamin B12 absorption.

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