Nursing Elites

1. Pain in the lower extremities due to peripheral artery disease usually worsens:

• A. with rest because blood flow increases.
• B. with elevation of the extremity because blood is diverted away.
• C. when the leg is in a dependent position because blood pools.
• D. when the leg is touched or massaged because cytokines are released.

Correct answer: B

Rationale: In peripheral artery disease, pain in the lower extremities worsens with the elevation of the extremity because it diverts blood flow away from the affected area, exacerbating the pain. Choices A, C, and D are incorrect. Resting doesn't increase blood flow, a dependent position doesn't lead to blood pooling in this context, and pain worsening due to touch or massage is not a typical feature of peripheral artery disease.

2. In nephritic syndrome compared to nephrotic syndrome, there is:

• A. higher amounts of albuminuria.
• B. negligible hematuria or absence of hematuria.
• C. presence of red blood cell casts in the urine.
• D. hypoalbuminemia

Correct answer: C

Rationale: In nephritic syndrome, the presence of red blood cell casts in the urine is a characteristic finding, reflecting glomerular inflammation and damage. This differentiates it from nephrotic syndrome, where red blood cell casts are typically absent. Choice A is incorrect because nephritic syndrome usually presents with less albuminuria compared to nephrotic syndrome. Choice B is incorrect as hematuria is a common feature of nephritic syndrome. Choice D is incorrect as hypoalbuminemia is more commonly associated with nephrotic syndrome.

3. Which of the following types of vitamin or mineral deficiency can cause megaloblastic anemia and is associated with lower extremity paresthesias?

• A. Vitamin B12
• B. Folate
• C. Iron
• D. Vitamin K

Correct answer: A

Rationale: The correct answer is Vitamin B12. Vitamin B12 deficiency can lead to megaloblastic anemia, a condition characterized by the production of abnormally large and immature red blood cells. Lower extremity paresthesias, such as tingling or numbness, are common neurological symptoms associated with vitamin B12 deficiency. Folate deficiency can also cause megaloblastic anemia but is not typically linked to lower extremity paresthesias. Iron deficiency leads to microcytic anemia, not megaloblastic anemia. Vitamin K deficiency is associated with bleeding tendencies, not megaloblastic anemia or paresthesias.

4. A client is brought to the emergency department after a motor vehicle accident in which she suffered a spinal cord injury at the level of C5. Which of the following assessments should be the priority?

• A. Monitoring urinary output
• B. Monitoring heart rate and rhythm
• C. Monitoring respiratory rate
• D. Monitoring the client's pain levels

Correct answer: B

Rationale: The correct answer is monitoring heart rate and rhythm. With a C5 spinal cord injury, monitoring heart rate and rhythm is crucial as it can impact autonomic regulation. This level of injury can affect cardiac function due to the disruption of sympathetic nerve fibers. Monitoring urinary output may be important to assess for urinary retention, but it is not the priority in this scenario. While monitoring respiratory rate is essential in all patients, in this case, cardiovascular stability takes precedence. Pain management is important but is not the priority when assessing a client with a C5 spinal cord injury.

5. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What key contraindication should the nurse review with the patient?

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

Correct answer: A

Rationale: The correct answer is A: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, so their combined use can lead to a dangerous drop in blood pressure. Choices B, C, and D are incorrect because while a history of hypertension or use of antihypertensive medications may influence treatment decisions, they are not the key contraindication specifically related to sildenafil use.

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