Nursing Elites

1. A patient with an 18 pack per year history presents to a family practice clinic complaining of painless hoarseness and inability to clear mucus. A biopsy of respiratory tract cells is taken and shows that these cells have been replaced by less mature squamous epithelium cells. The nurse knows this type of change is referred to as:

• A. Dysplasia
• B. Metaplasia
• C. Hyperplasia
• D. Coagulation

Correct answer: B

Rationale: Metaplasia is the replacement of one type of cell with another, which can occur in response to chronic irritation, such as from smoking. In this case, the respiratory tract cells being replaced by less mature squamous epithelium cells indicate metaplasia. Dysplasia refers to abnormal development or growth of cells, not replacement; hyperplasia is an increase in the number of cells, not a replacement; and coagulation is a process related to blood clotting, not cell replacement.

2. Which of the following would the nurse see in a client with thrombocytopenia?

• A. A decreased platelet cell count
• B. Decreased white blood cell count
• C. Increased red blood cell count
• D. An increased platelet cell count

Correct answer: A

Rationale: Thrombocytopenia is characterized by a decreased platelet cell count, leading to an increased risk of bleeding. Therefore, the correct answer is A. Choice B, a decreased white blood cell count, is not typically associated with thrombocytopenia. Choice C, an increased red blood cell count, is not a characteristic finding in thrombocytopenia. Choice D, an increased platelet cell count, is the opposite of what is observed in thrombocytopenia.

3. While assessing a critically ill client in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the client became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is:

• A. metabolic acidosis that occurs spontaneously following any dysrhythmias.
• B. interruption of the blood/oxygen supply to the brain.
• C. massive cerebrovascular accident (CVA) resulting from increased perfusion.
• D. a blood clot coming from the heart and occluding the carotid arteries.

Correct answer: B

Rationale: The correct answer is B. Ventricular tachycardia (VT) can disrupt the normal heart function, leading to a decreased cardiac output. This decreased output can interrupt the blood supply to the brain, causing the client to become unresponsive. Metabolic acidosis (Choice A) is not the most likely cause of unresponsiveness in this scenario. A massive cerebrovascular accident (CVA) (Choice C) would not result from increased perfusion. A blood clot occluding the carotid arteries (Choice D) may lead to a stroke but is not the most likely cause of sudden unresponsiveness in this situation.

4. A male patient is receiving testosterone therapy for hypogonadism. What adverse effect should the nurse monitor for during this therapy?

• A. Increased risk of cardiovascular events
• B. Increased risk of liver dysfunction
• C. Increased risk of prostate cancer
• D. Increased risk of bone fractures

Correct answer: A

Rationale: The correct answer is A: Increased risk of cardiovascular events. Testosterone therapy for hypogonadism is associated with an increased risk of cardiovascular events, such as myocardial infarction and stroke. Monitoring for signs and symptoms of cardiovascular issues is crucial during testosterone therapy. Choices B, C, and D are incorrect because testosterone therapy is not typically associated with an increased risk of liver dysfunction, prostate cancer, or bone fractures.

5. What potential risk should the nurse identify as being associated with infliximab (Remicade) in the treatment of rheumatoid arthritis?

• A. Risk for infection
• B. Risk for decreased level of consciousness
• C. Risk for nephrotoxicity
• D. Risk for hepatotoxicity

Correct answer: A

Rationale: The correct answer is A: Risk for infection. Infliximab (Remicade) is a medication used to treat autoimmune conditions like rheumatoid arthritis. One of the main risks associated with infliximab is an increased susceptibility to infections due to its immunosuppressive effects. This drug works by targeting specific proteins in the body's immune system, which can weaken the body's ability to fight off infections. Choices B, C, and D are incorrect because infliximab is not typically associated with decreased level of consciousness, nephrotoxicity, or hepatotoxicity. It is important for healthcare providers to monitor patients on infliximab for signs of infection and educate them on the importance of infection prevention strategies.

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