Nursing Elites

1. A patient underwent an open cholecystectomy 4 days ago, and her incision is now in the proliferative phase of healing. The nurse knows that the next step in the process of wound healing is:

• A. Inflammation
• B. Maturation
• C. Remodeling
• D. Coagulation

Correct answer: C

Rationale: In the context of wound healing, after the proliferative phase comes the remodeling phase. During the remodeling phase, the wound gains strength as collagen fibers reorganize, and the scar matures. Inflammation is the initial phase of healing, where the body responds to injury with redness, swelling, and warmth. Maturation is the final stage where the scar tissue continues to undergo changes but is not the immediate next step after the proliferative phase. Coagulation is the process of blood clot formation and is not a phase in wound healing.

2. A client is admitted with a suspected aortic dissection. What is the priority nursing intervention?

• A. Administer antihypertensive medications as prescribed.
• B. Prepare the client for emergency surgery.
• C. Administer intravenous fluids to maintain blood pressure.
• D. Monitor the client's urine output closely.

Correct answer: B

Rationale: The correct answer is B: Prepare the client for emergency surgery. Aortic dissection is a life-threatening emergency that often necessitates immediate surgical intervention to prevent rupture and further complications. Administering antihypertensive medications (choice A) may be necessary but is not the priority over surgical intervention. While maintaining blood pressure with intravenous fluids (choice C) is important, the urgent need for surgery takes precedence. Monitoring urine output (choice D) is essential for assessing renal function but is not the priority in this critical situation.

3. Which of the following nonpharmacologic treatments is most likely to be a useful and appropriate supplement to pharmacologic analgesia at this point?

• A. Cognitive-behavioral therapy
• B. Cold and heat application
• C. Therapeutic ultrasound
• D. Biofeedback

Correct answer: B

Rationale: The correct answer is B: Cold and heat application. Cold and heat application are commonly used nonpharmacologic methods for managing pain and can complement pharmacologic treatments. Cold packs can help reduce inflammation and numb localized areas, while heat application can increase blood flow and relax muscles. Cognitive-behavioral therapy (A) focuses on changing negative thought patterns and behaviors to manage pain but may not directly supplement pharmacologic analgesia. Therapeutic ultrasound (C) uses sound waves to generate heat within body tissues, which can be therapeutic, but it may not be as directly complementary to pharmacologic analgesia as cold and heat application. Biofeedback (D) involves using electronic devices to help individuals control physiological processes, but its direct role as a supplement to pharmacologic analgesia may be less pronounced compared to cold and heat application.

4. Two people experience the same stressor yet only one is able to cope and adapt adequately. An example of the person with an increased capacity to adapt is the one with:

• A. A sense of purpose in life
• B. Circadian rhythm disruption
• C. Age-related renal dysfunction
• D. Excessive weight gain or loss

Correct answer: A

Rationale: A strong sense of purpose in life is associated with better stress coping mechanisms, which can enhance a person's capacity to adapt. Having a clear sense of purpose provides individuals with motivation, direction, and resilience to face challenges. Choices B, C, and D are not directly related to an increased capacity to adapt to stress. Circadian rhythm disruption, age-related renal dysfunction, and excessive weight gain or loss may have negative impacts on overall well-being and stress management.

5. A 30-year-old has poorly controlled asthma and is taking prednisone 10 mg by mouth once a day. He has been on this regimen for 6 weeks. Abrupt withdrawal or discontinuation of this medication can cause:

• A. adrenal crisis
• B. hypercortisolism
• C. ACTH stimulation
• D. thyroid crisis

Correct answer: A

Rationale: Abrupt withdrawal or discontinuation of prednisone, a corticosteroid, can lead to adrenal crisis. This occurs due to the suppression of the adrenal glands' natural cortisol production caused by prolonged exogenous steroid administration. Adrenal crisis presents with symptoms such as weakness, fatigue, abdominal pain, and hypotension. Hypercortisolism (Cushing syndrome) results from chronic excessive exposure to cortisol, not abrupt withdrawal. ACTH stimulation would be expected in response to low cortisol levels, not as a direct consequence of prednisone withdrawal. Thyroid crisis (thyroid storm) is associated with severe hyperthyroidism and is not directly related to corticosteroid withdrawal.

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