Nursing Elites

1. For a client with suspected appendicitis, in which quadrant should the nurse expect to find abdominal tenderness?

• A. upper right
• B. upper left
• C. lower right
• D. lower left

Correct answer: C

Rationale: The correct answer is C: lower right. Abdominal tenderness in the lower-right quadrant is a classic sign of appendicitis. The appendix is located in the lower right abdomen, so inflammation of the appendix typically causes tenderness in this specific area. Choices A, B, and D are incorrect because tenderness in the upper right, upper left, and lower left quadrants, respectively, is not typical in appendicitis cases. Therefore, the nurse should focus on assessing the lower right quadrant for tenderness when suspecting appendicitis.

2. One drug can alter the absorption of another drug. One drug increases intestinal motility. Which effect does this have on the second drug?

• A. None; absorption of the second drug is not affected.
• B. The increased gut motility decreases the absorption of the second drug.
• C. The absorption of the second drug cannot be predicted.
• D. Less of the second drug is absorbed.

Correct answer: D

Rationale: When one drug increases intestinal motility, it accelerates the movement of the second drug through the system. Since most oral medications are absorbed in the intestine, the faster transit time decreases the absorption of the second drug. Therefore, less of the second drug is absorbed. Choice A is incorrect because the increased gut motility does affect the absorption of the second drug. Choice C is incorrect as the effect of increased intestinal motility on drug absorption can be predicted based on pharmacokinetic principles. Choice B is incorrect as increased gut motility would not increase but decrease the absorption of the second drug.

3. Which of the following is likely to increase the risk of sexually transmitted disease?

• A. alcohol use
• B. certain types of sexual practices
• C. oral contraception use
• D. all of the above

Correct answer: D

Rationale: All of the above factors are likely to increase the risk of sexually transmitted diseases (STDs). Alcohol use can impair judgment, leading to risky sexual behavior. Certain types of sexual practices, especially unprotected sex or multiple partners, increase the likelihood of contracting STDs. While oral contraception use does not directly increase the risk of STDs, it does not protect against them either. Therefore, all the choices (alcohol use, certain types of sexual practices, and oral contraception use) can contribute to an increased risk of contracting STDs.

4. A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:

• A. a maintenance dose.
• B. a loading dose.
• C. a medication with no first-pass effect.
• D. the medication to be given intravenously.

Correct answer: B

Rationale: To rapidly achieve a therapeutic plasma drug concentration, a loading or priming dose is ordered. This dose quickly establishes the desired drug level. It is calculated by multiplying the volume of distribution by the desired plasma drug concentration. A maintenance dose, like choice A, is used to maintain the therapeutic level after the loading dose. Waiting for steady state without a loading dose would take five drug half-lives. Choice C, a medication with no first-pass effect, does not directly address the need for rapid attainment of therapeutic levels. While intravenous administration (choice D) offers excellent bioavailability, a single dose by this route may not achieve the desired therapeutic plasma concentration as rapidly as a loading dose.

5. One day postoperative, the client complains of dyspnea, and his respiratory rate (RR) is 35, slightly labored, and there are no breath sounds in the lower-right base. The nurse should suspect:

• A. cor pulmonale.
• B. atelectasis.
• C. pulmonary embolism.
• D. cardiac tamponade.

Correct answer: B

Rationale: The correct answer is atelectasis. The absence of breath sounds in the lower-right base is a key finding in atelectasis, which occurs when a portion of the lung collapses. The other symptoms such as dyspnea and increased respiratory rate could be present in various pulmonary conditions. Cor pulmonale is typically associated with chronic lung disease, pulmonary embolism presents with sudden onset dyspnea and chest pain, and cardiac tamponade manifests with Beck's triad of hypotension, distended neck veins, and muffled heart sounds.

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