Nursing Elites

1. A woman is complaining that she feels like the room is spinning even though she is not moving. Which of the following is characteristic of benign positional vertigo?

• A. It usually occurs with a headache.
• B. Pupillary changes are common.
• C. It is usually triggered when the patient bends forward.
• D. Nystagmus continues even when eyes fixate on an object.

Correct answer: C

Rationale: Benign positional vertigo is typically triggered by changes in head position, such as bending forward or turning over in bed. This change in position leads to brief episodes of vertigo, often associated with nystagmus, which is rapid, involuntary eye movements. Pupillary changes and headaches are not typical features of benign positional vertigo, making choices B and A incorrect. Nystagmus in benign positional vertigo usually stops when the eyes fixate on an object, so choice D is also incorrect.

2. In Guillain-Barre syndrome, what pathophysiologic process underlies the deficits that accompany the degeneration of myelin in the peripheral nervous system (PNS)?

• A. The destruction of myelin results in a reduction in Schwann cell production in the client's PNS.
• B. The lack of myelin surrounding nerve cells compromises the axonal transport system.
• C. Without remyelination, the axon will eventually die.
• D. A deficit of myelin makes the client more susceptible to infection by potential pathogens.

Correct answer: C

Rationale: In Guillain-Barre syndrome, the destruction of myelin leads to axonal damage. If remyelination does not occur, the axon will eventually degenerate and die, impacting nerve function. Choice A is incorrect because the destruction of myelin does not affect Schwann cell production. Choice B is incorrect as the lack of myelin directly affects the conduction of nerve impulses, not the axonal transport system. Choice D is incorrect as a deficit of myelin does not predispose the client to infections by potential pathogens.

3. A client with heart failure is experiencing pulmonary edema. Which intervention should be prioritized?

• A. Administer diuretics to reduce fluid overload.
• B. Position the client in high-Fowler's position.
• C. Administer oxygen therapy to improve oxygenation.
• D. Restrict fluid intake to prevent further fluid overload.

Correct answer: C

Rationale: In a client experiencing pulmonary edema due to heart failure, the priority intervention is to administer oxygen therapy to improve oxygenation. This helps in increasing the oxygen levels in the blood, thereby improving tissue perfusion and reducing the workload on the heart. Positioning the client in high-Fowler's position can also aid in improving oxygenation, but administering oxygen therapy directly addresses the immediate need for increased oxygen levels. Administering diuretics to reduce fluid overload and restricting fluid intake are important interventions in heart failure management, but in the acute situation of pulmonary edema, oxygen therapy takes precedence to ensure adequate oxygen supply to vital organs.

4. A woman has been prescribed Climara, a transdermal estradiol patch. Which of the following should she be instructed by the nurse regarding the administration?

• A. Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.
• B. The application of heat at the patch site will decrease effectiveness and result in pregnancy.
• C. The medication, when exposed to sunlight, can increase the risk of breast cancer.
• D. Exposure of the medication to occasional cold will increase effectiveness with application.

Correct answer: A

Rationale: The correct answer is A. The Climara patch delivers estradiol transdermally, and patients should be instructed to avoid prolonged sun exposure at the patch site due to increased plasma concentrations. Sun exposure can accelerate the absorption of the medication, leading to higher systemic levels than intended. Choices B, C, and D are incorrect because heat at the patch site does not result in pregnancy but may alter absorption rates, there is no direct link between sunlight exposure and breast cancer risk related to this medication, and exposure to cold does not increase effectiveness of the transdermal patch.

5. What is the cause of swelling during acute inflammation?

• A. Collagenase
• B. Fluid exudate
• C. Lymphocytic margination
• D. Anaerobic glycolysis

Correct answer: B

Rationale: Swelling during acute inflammation is primarily caused by the accumulation of fluid exudate in the affected tissues. This fluid exudate contains proteins and cells that leak from blood vessels due to increased vascular permeability. Collagenase (Choice A) is an enzyme that breaks down collagen and is not directly responsible for swelling. Lymphocytic margination (Choice C) is the process where white blood cells line up along the blood vessel walls, which does not directly cause swelling. Anaerobic glycolysis (Choice D) is a metabolic process that occurs in the absence of oxygen and is not related to the mechanism of swelling in acute inflammation.

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