Nursing Elites

1. A patient presents with a sudden onset of severe chest pain radiating to his back. His blood pressure is significantly higher in the right arm than in the left arm. Which of the following conditions is most likely?

• A. Acute myocardial infarction
• B. Pulmonary embolism
• C. Aortic dissection
• D. Pericarditis

Correct answer: C

Rationale: The correct answer is C, aortic dissection. Aortic dissection is characterized by sudden, severe chest pain that can radiate to the back. The discrepancy in blood pressure between the arms (higher in the right arm) is known as a 'pulse deficit' and is a classic finding in aortic dissection. This condition involves a tear in the inner layer of the aorta, leading to the abnormal flow of blood within the aortic wall. Acute myocardial infarction (choice A) presents with chest pain but typically does not cause discrepancies in blood pressure between arms. Pulmonary embolism (choice B) usually presents with chest pain and difficulty breathing but does not cause unequal blood pressures in the arms. Pericarditis (choice D) can cause chest pain exacerbated by breathing or lying down, but it does not typically lead to differences in blood pressure between arms.

2. The nurse is closely following a patient who began treatment with testosterone several months earlier. When assessing the patient for potential adverse effects of treatment, the nurse should prioritize which of the following assessments?

• A. Skin inspection for developing lesions
• B. Lung function testing
• C. Assessment of serum calcium levels
• D. Assessment of arterial blood gases

Correct answer: C

Rationale: In patients receiving testosterone therapy, the nurse should prioritize assessing serum calcium levels. Testosterone therapy can lead to hypercalcemia, making the evaluation of serum calcium levels crucial. Skin inspection for developing lesions, lung function testing, and arterial blood gas assessment are not the priority assessments for potential adverse effects of testosterone therapy. Skin inspection may be relevant for dermatological side effects, lung function testing and arterial blood gas assessment are not directly related to the common side effects of testosterone therapy.

3. A nurse is conducting an assessment on a client who presents with symptoms that are characteristic of amyotrophic lateral sclerosis (ALS). What assessment finding would be expected in this client?

• A. Reduced reflexes in all four limbs
• B. Decreased cognitive function
• C. Involuntary muscle contractions
• D. Hyperreflexia

Correct answer: D

Rationale: The correct answer is D: Hyperreflexia. In amyotrophic lateral sclerosis (ALS), hyperreflexia is a common assessment finding due to the degeneration of upper motor neurons. This results in an overactive reflex response to stimuli. Reduced reflexes in all four limbs (choice A) are not typically seen in ALS; instead, hyperreflexia is more common. Decreased cognitive function (choice B) is not a primary characteristic of ALS. Involuntary muscle contractions (choice C) are more indicative of conditions such as dystonia or myoclonus, not ALS.

4. After teaching the students about B cells, which statement indicates teaching was successful? B cells are originally derived from cells of the:

• A. Bone marrow
• B. Lymph nodes
• C. Gut-associated lymphoid tissue
• D. Thymus

Correct answer: A

Rationale: The correct answer is A: Bone marrow. B cells are originally derived from cells of the bone marrow. Bone marrow is the primary site where B cells develop and mature. Lymph nodes (choice B), gut-associated lymphoid tissue (choice C), and the thymus (choice D) are involved in the immune response but are not the primary site of origin for B cells.

5. Mrs. Jordan is an elderly client diagnosed with Alzheimer’s disease. She becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to:

• A. tell the client firmly that it is time to get dressed.
• B. obtain assistance to restrain the client for safety.
• C. remain calm and talk quietly to the client.
• D. call the doctor and request an order for sedation.

Correct answer: C

Rationale: When dealing with an elderly client with Alzheimer’s disease who is agitated and combative, the most appropriate nursing intervention is to remain calm and talk quietly to the client. This approach can help soothe the client and prevent escalating the situation. Choice A is incorrect as being firm may further agitate the client. Choice B is inappropriate as restraining should only be used as a last resort for safety reasons and after other de-escalation techniques have been attempted. Choice D is not the best initial intervention and should only be considered after other non-pharmacological interventions have failed.

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