Nursing Elites

1. The nurse instructs the mother of a child with a ventricular septal defect that she can expect the child to become cyanotic when the child does what?

• A. Experiences an elevation in temperature.
• B. Sleeps on the left side.
• C. Cries vigorously.
• D. Eats.

Correct answer: C

Rationale: The correct answer is C: Cries vigorously. When the child cries vigorously, it increases the pressure in the right ventricle, allowing unoxygenated blood to enter the circulating volume, leading to cyanosis. This occurs due to the shunting of blood from the right side of the heart to the left side through the ventricular septal defect. Choices A, B, and D are incorrect because they do not directly impact the pressure in the right ventricle, which is crucial in causing cyanosis in this scenario.

2. A woman with chronic osteoarthritis is complaining of knee pain. Which pathophysiological process is contributing to her pain?

• A. Inflammation of the synovial membrane.
• B. Degeneration of the cartilage in the joint.
• C. Joint inflammation occurs when chondrocyte injury destroys joint cartilage, producing osteophytes.
• D. Formation of uric acid crystals in the joint space.

Correct answer: C

Rationale: The correct answer is C. In osteoarthritis, the breakdown of cartilage in the joints leads to chondrocyte injury, which results in the destruction of joint cartilage and the production of osteophytes. This process causes joint inflammation and pain. Choice A is incorrect because osteoarthritis primarily involves the articular cartilage rather than the synovial membrane. Choice B is incorrect as it describes the degeneration of cartilage but does not explain the specific pathophysiological process contributing to pain in osteoarthritis. Choice D is incorrect as the formation of uric acid crystals is characteristic of gout, not osteoarthritis.

3. The wife of a client with Parkinson's disease expresses concern because her husband has lost so much weight. Which teaching is best for the nurse to provide?

• A. Invite friends over regularly to share meal times
• B. Encourage the client to drink clear liquids between meals
• C. Coach the client to make an intentional effort to swallow
• D. Talk to the healthcare provider about prescribing an appetite stimulant

Correct answer: A

Rationale: The best teaching for the nurse to provide is to invite friends over regularly to share meal times. This can help in making meal times more enjoyable for the client with Parkinson's disease, potentially encouraging him to eat more. Encouraging clear liquids between meals (choice B) may not address the underlying issue of weight loss. Coaching the client to make an intentional effort to swallow (choice C) may not be effective if the weight loss is due to other factors related to Parkinson's disease. While prescribing an appetite stimulant (choice D) could be an option, it is usually recommended to explore non-pharmacological interventions first, making choice A the most appropriate initial teaching intervention.

4. A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which pathophysiological process supports the client’s respiratory acidosis?

• A. Low oxygen levels are present in the blood.
• B. High levels of carbon dioxide have accumulated in the blood.
• C. Increased bicarbonate levels are causing alkalosis.
• D. Respiratory rate is increased, causing hyperventilation.

Correct answer: B

Rationale: High levels of carbon dioxide in the blood lead to respiratory acidosis due to inadequate ventilation. The correct answer is B. In respiratory acidosis, the accumulation of carbon dioxide in the blood occurs due to inadequate exhalation, leading to acidosis. Choice A is incorrect as low oxygen levels are related to hypoxemia, not respiratory acidosis. Choice C is incorrect as increased bicarbonate levels would lead to alkalosis, not acidosis. Choice D is incorrect as an increased respiratory rate causing hyperventilation would actually help decrease carbon dioxide levels, not lead to respiratory acidosis.

5. An older adult woman with a long history of COPD is admitted with progressive shortness of breath and a persistent cough, is anxious, and is complaining of dry mouth. Which intervention should the nurse implement?

• A. Administer a prescribed sedative
• B. Encourage client to drink water
• C. Apply a high flow venturi mask
• D. Assist her to an upright position

Correct answer: D

Rationale: Assisting the client to an upright position is the most appropriate intervention in this situation. Placing the client upright helps improve lung expansion by reducing diaphragmatic pressure, facilitating better air exchange, and increasing oxygenation. This position also aids in easing breathing efforts. Administering a sedative (Choice A) may further depress the respiratory system, worsening the breathing problem. Encouraging the client to drink water (Choice B) may not directly address the respiratory distress caused by COPD. Applying a high flow venturi mask (Choice C) may be beneficial in some cases but assisting the client to an upright position should be the priority to optimize respiratory function.

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