Nursing Elites

1. What symptoms would the nurse expect to see in a client with chronic obstructive pulmonary disease (COPD)?

• A. Dyspnea on exertion
• B. Normal lung sounds
• C. Normal arterial blood gases
• D. Onset of the disease during young adulthood

Correct answer: A

Rationale: The correct answer is A: Dyspnea on exertion. COPD typically manifests with symptoms like dyspnea on exertion due to impaired lung function. This symptom is a result of the airways being obstructed and the lungs not being able to expel air effectively. Choices B and C are incorrect because in COPD, abnormal lung sounds such as wheezing, crackles, or diminished breath sounds are often heard upon auscultation, and arterial blood gases are usually abnormal, showing low oxygen levels and high carbon dioxide levels. Choice D is incorrect as COPD is more commonly diagnosed in individuals over 40 who have a history of smoking or exposure to lung irritants.

2. A 54-year-old man presents with a temperature of 38.8°C (101.8°F), a racing heart, fatigue, and an upset stomach after spending an afternoon building a deck on a very hot, humid day. The physician assessing the man is performing a differential diagnosis as part of her assessment. Which finding would suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature?

• A. Absence of sweating
• B. Shivering
• C. Lack of thirst
• D. Increased heart rate

Correct answer: B

Rationale: Shivering is a physiological response to fever, as the body attempts to generate heat to increase the internal temperature. Hyperthermia, on the other hand, does not involve shivering. Absence of sweating (choice A) is more indicative of hyperthermia, as the body struggles to cool down without sweating. Lack of thirst (choice C) can be seen in both fever and hyperthermia. Increased heart rate (choice D) can occur in both fever and hyperthermia due to the body's attempt to regulate temperature.

3. A patient was sneezing frequently after a few days of allergic rhinitis, and she noticed her eye became red. She denies any trauma, eye pain, or visual disturbance. Physical examination reveals a subconjunctival hemorrhage. Which statement is accurate pertaining to this case?

• A. The hemorrhage will resolve without treatment within 2 weeks.
• B. The patient should be referred for immediate ophthalmologic examination.
• C. Corticosteroid eye drops will be prescribed to reduce the bleeding.
• D. Antibiotic eye drops will be prescribed to prevent infection.

Correct answer: A

Rationale: The correct answer is A: 'The hemorrhage will resolve without treatment within 2 weeks.' Subconjunctival hemorrhage typically resolves on its own without treatment. It is a self-limiting condition that does not require specific intervention. Choice B is incorrect as immediate ophthalmologic examination is not necessary for subconjunctival hemorrhage unless there are other concerning symptoms or risk factors present. Choice C is incorrect because corticosteroid eye drops are not typically used for subconjunctival hemorrhage. Choice D is also incorrect as antibiotic eye drops are not indicated since subconjunctival hemorrhage is not due to an infection.

4. How does influenza immunization produce immunity?

• A. The virus from the vaccine remains in the body until the end of the season
• B. An attenuated virus causes immune system suppression and triggers immunity
• C. The body identifies the virus and develops antibodies against the virus
• D. The vaccine remains in the injection site and produces immune cells

Correct answer: C

Rationale: The correct answer is C. Influenza immunization works by introducing a weakened or inactivated form of the virus into the body, allowing the immune system to recognize it as foreign. This recognition triggers the production of antibodies specific to the virus. Choice A is incorrect as the virus in the vaccine does not remain in the body until the end of the season. Choice B is incorrect as an attenuated virus does not cause immune system suppression but rather stimulates an immune response. Choice D is incorrect because the vaccine does not stay at the injection site but rather prompts a systemic immune response throughout the body.

5. A 40-year-old man has been living with HIV for several years but experienced a significant decrease in his CD4+ levels a few months ago. The patient has just been diagnosed with Mycobacterium avium complex disease. The nurse should anticipate administering which of the following medications?

• A. Clarithromycin
• B. Pyrazinamide
• C. Rifapentine (Priftin)
• D. Azithromycin

Correct answer: A

Rationale: The correct answer is A: Clarithromycin. In the case of Mycobacterium avium complex disease, a common treatment regimen includes a macrolide antibiotic like clarithromycin or azithromycin in combination with other antimicrobials. Clarithromycin is a key component of the treatment due to its effectiveness against Mycobacterium avium complex. Choice B (Pyrazinamide) is not typically part of the standard treatment for this condition. Choice C (Rifapentine) is mainly used in tuberculosis treatment and is not a primary agent for Mycobacterium avium complex disease. Choice D (Azithromycin) is another suitable macrolide antibiotic for treating Mycobacterium avium complex disease but is not the medication typically used first-line.

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