Nursing Elites

1. The client with peripheral vascular disease (PVD) and a history of heart failure may have a low tolerance for exercise due to:

• A. Decreased blood flow.
• B. Increased blood flow.
• C. Decreased pain.
• D. Increased blood viscosity.

Correct answer: A

Rationale: The correct answer is A: Decreased blood flow. In clients with peripheral vascular disease (PVD) and a history of heart failure, decreased blood flow due to heart failure can result in reduced oxygen delivery to tissues. This reduced oxygen supply can lead to low exercise tolerance. Increased blood flow (Choice B) is not typically associated with reduced exercise tolerance in these clients. Decreased pain (Choice C) and increased blood viscosity (Choice D) are not the primary factors contributing to low exercise tolerance in this scenario.

2. A young adult asks the nurse about the normal cholesterol level. The nurse tells the client that the total cholesterol level should be maintained at less than:

• A. 140 mg/dL
• B. 200 mg/dL
• C. 250 mg/dL
• D. 300 mg/dL

Correct answer: B

Rationale: The correct answer is B: 200 mg/dL. A normal cholesterol value ranges between 140 and 199 mg/dL. Total cholesterol levels should ideally be maintained at 200 mg/dL or less to reduce the risk of cardiovascular diseases. Choices A, C, and D are incorrect as they exceed the recommended normal range for total cholesterol levels and may increase the risk of developing heart-related issues.

3. A nurse is conducting an assessment of a client who underwent thoracentesis of the right side of the chest 3 hours ago. Which findings does the nurse report to the physician? Select all that apply.

• A. Unequal chest expansion
• B. Pulse rate of 82 beats/min
• C. Respiratory rate of 22 breaths/min
• D. Diminished breath sounds in the right lung

Correct answer: A

Rationale: After thoracentesis, the nurse should assess the client for signs of pneumothorax, which include increased respiratory rate, dyspnea, retractions, unequal chest expansion, diminished breath sounds, and cyanosis. Unequal chest expansion is a key sign of pneumothorax due to the accumulation of air in the pleural space, causing the affected lung to collapse partially. Pulse rate and respiratory rate within normal ranges, like in choices B and C, are not the priority findings to report in this situation. Diminished breath sounds in the right lung could be expected after thoracentesis and may not necessarily indicate a complication like pneumothorax, making choice D less urgent to report.

4. After three days of persistent epigastric pain, a female client presents to the clinic. She has been taking oral antacids without relief. Her vital signs are heart rate 122 beats/minute, respirations 16 breaths/minute, oxygen saturation 96%, and blood pressure 116/70. The nurse obtains a 12-lead electrocardiogram (ECG). Which assessment finding is most critical?

• A. Irregular pulse rhythm
• B. Bile-colored emesis
• C. ST elevation in three leads
• D. Complaint of radiating jaw pain

Correct answer: C

Rationale: ST elevation in three leads is a critical finding that suggests myocardial infarction, requiring immediate attention. This finding indicates ischemia or injury to the heart muscle. Choices A, B, and D are not as critical in this scenario. Irregular pulse rhythm may be concerning but does not indicate an immediate life-threatening condition like myocardial infarction. Bile-colored emesis and complaint of radiating jaw pain are relevant but not as indicative of a myocardial infarction as ST elevation in three leads.

5. Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay the development of:

• A. Chronic obstructive pulmonary disease (COPD).
• B. Pancreatic cancer.
• C. Renal failure.
• D. Cerebrovascular accident.

Correct answer: C

Rationale: The correct answer is C: Renal failure. ACE inhibitors are commonly used in clients with diabetes mellitus to help reduce the progression of diabetic nephropathy by improving renal blood flow. This medication class can help prevent or delay the development of renal failure in these clients. Choices A, B, and D are incorrect because ACE inhibitors do not have a direct impact on preventing or delaying the development of chronic obstructive pulmonary disease, pancreatic cancer, or cerebrovascular accidents in clients with diabetes mellitus.

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