Nursing Elites

1. Select the stage of shock that is accurately paired with its characteristic.

• A. The initial stage of shock: Hyperventilation occurs and the blood pH rises.
• B. The compensatory stage of shock: Hypoxia occurs and lactic acid rises.
• C. The progressive stage of shock: Histamine is released; fluid and proteins leak into surrounding tissues and the blood thickens.
• D. The refractory stage of shock: Potassium ions leak out; sodium ions build up, and metabolic acidosis increases.

Correct answer: C

Rationale: The progressive stage of shock is accurately described as the stage where histamine is released, leading to fluid and proteins leaking into surrounding tissues and the blood thickening. In this stage, the body's compensatory mechanisms are overwhelmed, resulting in a cascade of events that worsen the shock state. Choice A is incorrect as hyperventilation and a rise in blood pH are more characteristic of the compensatory stage. Choice B is incorrect as hypoxia and a rise in lactic acid are more typical of the progressive stage. Choice D is incorrect as the described electrolyte imbalances and metabolic acidosis are more aligned with the refractory stage of shock.

2. Based on the signs and symptoms of erythema marginatum, Sydenham chorea, epistaxis, abdominal pain, fever, cardiac problems, and skin nodules in your 32-year-old female patient, what disorder would you most likely suspect?

• A. Leukemia
• B. Histoplasmosis
• C. Pneumocystis jiroveci
• D. Rheumatoid arthritis

Correct answer: D

Rationale: The signs and symptoms described point towards rheumatoid arthritis. Erythema marginatum, Sydenham chorea, epistaxis, abdominal pain, fever, cardiac issues, and skin nodules are classic manifestations of rheumatic fever, which is a complication of untreated streptococcal infection. This condition can lead to rheumatoid arthritis over time. Choices A, B, and C are incorrect as they do not align with the provided signs and symptoms, and they are not associated with the clinical presentation described.

3. A nurse manager is leading a discussion about ethical dilemmas. Which of the following situations should the nurse manager include as an example of an ethical dilemma?

• A. A visitor experiences a minor burn after spilling coffee
• B. A client receives an operation on the wrong side of her body
• C. A parent wants her 14-year-old adolescent to receive radiation treatment against his will
• D. A nurse witnesses another nurse administer an incorrect medication

Correct answer: C

Rationale: An ethical dilemma involves a situation where moral principles conflict, such as in the case of a parent wanting their adolescent to receive treatment against their will. In option A, a minor burn from spilled coffee does not present a conflict of moral principles. Option B describes a medical error, not necessarily a conflict of moral principles. Option D involves an issue of professional practice and patient safety but does not inherently pose a conflict of moral principles.

4. A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level?

• A. The client with renal failure
• B. The client who is taking diuretics
• C. The client with hyperaldosteronism
• D. The client who is taking corticosteroids

Correct answer: B

Rationale: The correct answer is B. Clients taking diuretics are at risk for hyponatremia due to excessive sodium loss. In this scenario, a sodium level of 130 mEq/L indicates hyponatremia, which is commonly associated with diuretic use. Options A, C, and D are not the highest risk factors for developing low sodium levels in this context. Renal failure, hyperaldosteronism, and corticosteroid use are not directly linked to sodium loss as seen with diuretics.

5. A client is preparing for an elective mastectomy. The client is wearing a plain gold wedding band. Which of the following is an appropriate procedure for taking care of this client's ring?

• A. Agree to keep the ring for the client until after surgery
• B. Place the ring in the bag with the client's clothing
• C. Tape the ring securely to the client's finger
• D. Place the client's ring in the facility safe

Correct answer: D

Rationale: In this scenario, placing the client's ring in the facility safe is the most appropriate procedure. This ensures the ring is kept secure and prevents any risk of loss or damage during the surgery. Agreeing to keep the ring for the client could raise concerns about accountability, while placing it in the bag with the client's clothing might lead to misplacement. Taping the ring securely to the client's finger is not recommended as it may hinder blood circulation or cause discomfort.

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