Nursing Elites

1. What pathophysiological events occur sequentially in the development of atherosclerosis?

• A. Foam cells release growth factors.
• B. Smooth muscle grows over fatty streaks creating fibrous plaques.
• C. Macrophages consume low-density lipoprotein (LDL) and create foam cells.
• D. Arterial endothelium injury causes inflammation.

Correct answer: D

Rationale: The correct sequence of pathophysiological events in the development of atherosclerosis starts with arterial endothelium injury causing inflammation. This inflammation triggers the formation of foam cells by macrophages consuming low-density lipoprotein (LDL). Subsequently, smooth muscle grows over fatty streaks, creating fibrous plaques. Therefore, option D is the correct answer. Choices A, B, and C are incorrect because they do not reflect the accurate chronological order of events in the pathogenesis of atherosclerosis.

2. The nurse is caring for a client with a traumatic brain injury who is receiving mechanical ventilation. Which assessment finding indicates that the client may be experiencing increased intracranial pressure (ICP)?

• A. Client becomes increasingly lethargic
• B. Client's respiratory rate is 16 breaths per minute
• C. Client responds to verbal stimuli
• D. Client's pupils are equal and reactive

Correct answer: A

Rationale: Increased lethargy is a sign of worsening intracranial pressure, which can be life-threatening in clients with brain injuries. As ICP rises, it can lead to decreased level of consciousness, such as lethargy or even coma. Choices B, C, and D are not indicative of increased ICP. A normal respiratory rate, response to verbal stimuli, and equal reactive pupils do not specifically point towards increased intracranial pressure.

3. A client with chronic obstructive pulmonary disease (COPD) is experiencing difficulty breathing. What is the nurse's priority intervention?

• A. Administer a bronchodilator via nebulizer.
• B. Increase the client's oxygen flow rate.
• C. Elevate the head of the bed.
• D. Reposition the client to a side-lying position.

Correct answer: B

Rationale: In clients with COPD experiencing difficulty breathing, increasing the client's oxygen flow rate is the priority intervention. This action helps to improve oxygenation and relieve shortness of breath. While bronchodilators and other medications may be necessary, providing immediate oxygen support is crucial. Elevating the head of the bed and repositioning the client can assist with breathing comfort but do not address the immediate need for improved oxygenation in COPD exacerbation.

4. A client with a ruptured spleen underwent an emergency splenectomy. Twelve hours later, the client’s urine output is 25 ml/hour. What is the most likely cause?

• A. This is a normal finding after surgery.
• B. Oliguria signals tubular necrosis related to hypoperfusion.
• C. Oliguria signals dehydration and fluid loss.
• D. Urine output of 25 ml/hour is an expected finding after splenectomy.

Correct answer: B

Rationale: Oliguria, or decreased urine output, after surgery can indicate tubular necrosis due to hypoperfusion, which may require intervention to restore renal function. Choice A is incorrect as oliguria is not a normal finding after surgery. Choice C is incorrect because dehydration is less likely in this context compared to tubular necrosis. Choice D is incorrect as a urine output of 25 ml/hour is not expected after splenectomy and should raise concern for renal impairment.

5. The nurse is feeding an older adult who was admitted with aspiration pneumonia. The client is weak and begins coughing while attempting to drink through a straw. Which intervention should the nurse implement?

• A. Encourage the client to drink more slowly
• B. Stop feeding and assess for signs of aspiration
• C. Elevate the head of the bed further
• D. Teach coughing and deep breathing exercises

Correct answer: B

Rationale: When an older adult with aspiration pneumonia coughs while attempting to drink, it may indicate aspiration. Aspiration can lead to serious complications. Therefore, the appropriate intervention for the nurse in this situation is to stop feeding immediately and assess the client for signs of aspiration. Encouraging the client to drink more slowly (Choice A) may not address the risk of aspiration. Elevating the head of the bed further (Choice C) is generally beneficial to prevent aspiration but is not the priority when immediate assessment is needed. Teaching coughing and deep breathing exercises (Choice D) is not appropriate when the client is actively coughing during feeding and requires immediate assessment for potential aspiration.

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