Nursing Elites

1. An older adult patient has just sheared the skin on her elbow while attempting to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patient's inflammation?

• A. Outpouring of exudate into interstitial spaces
• B. Chemotaxis
• C. Accumulation of leukocytes along epithelium
• D. Phagocytosis of cellular debris

Correct answer: A

Rationale: During the vascular stage of inflammation, there is an outpouring of exudate into the interstitial spaces, leading to swelling and edema. Choice B, chemotaxis, occurs during the cellular stage of inflammation, where leukocytes move to the site of injury in response to chemical signals. Choice C, accumulation of leukocytes along the epithelium, is not a typical event during the vascular stage. Phagocytosis of cellular debris, as in choice D, mainly occurs during the resolution stage of inflammation.

2. A client has been admitted to the hospital with symptoms of Guillain-Barré syndrome. Which aspect of the client's condition would require priority monitoring?

• A. Monitoring oxygen saturation levels
• B. Monitoring for signs of respiratory compromise
• C. Monitoring for changes in consciousness
• D. Monitoring blood pressure closely

Correct answer: B

Rationale: In Guillain-Barré syndrome, respiratory muscle weakness can lead to respiratory compromise, making it crucial to prioritize monitoring for signs of respiratory distress. Monitoring oxygen saturation levels is important but is secondary to assessing for respiratory compromise in this condition. Changes in consciousness and monitoring blood pressure closely are not typically the priority in Guillain-Barré syndrome.

3. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What important contraindication should the nurse emphasize during patient education?

• A. Use of nitrates
• B. History of hypertension
• C. History of peptic ulcer disease
• D. Use of antihypertensive medications

Correct answer: A

Rationale: The correct answer is A: 'Use of nitrates.' Sildenafil (Viagra) is contraindicated in patients using nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, leading to a synergistic effect that can result in a dangerous drop in blood pressure. Choices B, C, and D are incorrect because they are not direct contraindications for sildenafil use. While a history of hypertension or peptic ulcer disease may require caution, they are not absolute contraindications like the concomitant use of nitrates.

4. How will taking an oral contraceptive affect the physiologically of an insulin-dependent diabetic patient?

• A. Increase risk of hypoglycemia
• B. Increase heart rate
• C. Increase blood glucose
• D. Increase risk of metabolic alkalosis

Correct answer: C

Rationale: Taking an oral contraceptive can lead to an increase in blood glucose levels in insulin-dependent diabetic patients. This occurs due to the hormonal changes induced by the contraceptive, which can impact insulin sensitivity. Therefore, diabetic patients need to closely monitor their blood glucose levels when starting an oral contraceptive to prevent complications. The other choices are incorrect as oral contraceptives do not typically lead to an increase in heart rate, risk of hypoglycemia, or risk of metabolic alkalosis in this context.

5. What are the signs of thyroid crisis resulting from Graves' disease?

• A. Constipation with gastric distension.
• B. Bradycardia and bradypnea.
• C. Hyperthermia and tachycardia.
• D. Constipation and lethargy.

Correct answer: C

Rationale: In a thyroid crisis resulting from Graves' disease, the patient typically experiences symptoms such as hyperthermia (elevated body temperature) and tachycardia (rapid heart rate). These symptoms are indicative of the hypermetabolic state seen in thyroid storm. Choices A and D are incorrect as constipation and lethargy are not typical signs of a thyroid crisis; instead, patients with hyperthyroidism often experience diarrhea and agitation. Choice B is incorrect because bradycardia (slow heart rate) and bradypnea (slow breathing rate) are more commonly associated with hypothyroidism rather than a thyroid crisis in Graves' disease.

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