Nursing Elites

1. The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider?

• A. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97%
• B. pH 7.35, PaO2 85 mm Hg, PaCO2 45 mm Hg, and O2 sat 95%
• C. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98%
• D. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

Correct answer: D

Rationale: The correct answer is D: pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%. These ABG results indicate uncompensated respiratory acidosis, a critical condition that requires immediate attention. In respiratory acidosis, there is an excess of carbon dioxide in the blood, leading to a decrease in pH. The other options present normal or near-normal ABG values, indicating adequate oxygenation and ventilation. Therefore, these values would not be as urgent to report compared to the patient with respiratory acidosis in option D.

2. Which of the following diseases or disorders is acute?

• A. Pneumonia
• B. Paralysis
• C. Alzheimer's disease
• D. Diabetes

Correct answer: A

Rationale: The correct answer is Pneumonia. Pneumonia is an acute illness characterized by inflammation of the air sacs in the lungs. It comes on suddenly and typically lasts for a short duration. Treatment can help cure pneumonia. Paralysis, Alzheimer's disease, and Diabetes are chronic conditions. Paralysis is the loss of muscle function in part of the body, usually permanent. Alzheimer's disease is a progressive brain disorder leading to memory loss and cognitive decline, and it is incurable. Diabetes is a chronic condition that affects how your body turns food into energy, and it requires lifelong management. Therefore, Pneumonia is the only acute condition among the options provided.

3. Which clinical manifestations are recognized in nephrotic syndrome?

• A. Hematuria, bacteriuria, weight gain
• B. Gross hematuria, albuminuria, fever
• C. Hypertension, weight loss, proteinuria
• D. Massive proteinuria, hypoalbuminemia, edema

Correct answer: D

Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema. In this syndrome, there is loss of proteins, particularly albumin, in the urine leading to hypoalbuminemia, fluid retention, and subsequent edema. This results in elevated lipid levels like hypercholesterolemia, but not hypertension. Therefore, choices A, B, and C are incorrect. Hematuria, bacteriuria, fever, and weight loss are not typically associated with nephrotic syndrome, distinguishing it from other kidney disorders.

4. A patient's chart indicates a history of meningitis. Which of the following would you NOT expect to see with this patient if this condition were acute?

• A. Increased appetite
• B. Vomiting
• C. Fever
• D. Poor tolerance of light

Correct answer: A

Rationale: The correct answer is 'Increased appetite.' In cases of acute meningitis, loss of appetite would be expected rather than an increase. Meningitis is often caused by an infectious agent that colonizes or infects various sites in the body, leading to systemic symptoms. Common symptoms of acute meningitis include fever, vomiting, and poor tolerance of light due to meningeal irritation. The inflammatory response in the meninges can result in symptoms like photophobia. Increased appetite is not typically associated with acute meningitis. Therefore, choice A is the least likely symptom to be observed in a patient with acute meningitis. Choices B, C, and D are symptoms commonly seen in acute meningitis due to the inflammatory process affecting the central nervous system and meninges.

5. The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement?

• A. I will make an appointment to see the doctor every year.
• B. I will stop taking the prednisone if I experience a dry cough.
• C. I will not worry if I feel a little short of breath with exercise.
• D. I will call the health care provider right away if I develop a fever.

Correct answer: D

Rationale: The correct answer is, 'I will call the health care provider right away if I develop a fever.' It is crucial for patients who have undergone a lung transplant to be vigilant about any signs of infection or rejection. A low-grade fever can be an early indicator of such complications, requiring immediate medical attention. While annual follow-up visits are necessary, they are not sufficient for monitoring acute changes in health post-transplant. Stopping prednisone abruptly can lead to rejection and should only be done under healthcare provider guidance. Feeling short of breath with exercise should be reported as it can indicate potential issues. Recognizing and addressing symptoms promptly is key to successful post-transplant care, and in this case, calling the healthcare provider immediately for a fever is the most appropriate action.

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