Nursing Elites

1. Which of the following is a common cause of chronic obstructive pulmonary disease (COPD)?

• A. Smoking
• B. Asthma
• C. Allergies
• D. Chronic bronchitis

Correct answer: A

Rationale: Smoking is the correct answer as it is a well-established common cause of chronic obstructive pulmonary disease (COPD). Smoking leads to long-term damage to the lungs, contributing to the development of COPD. Choice B, asthma, is not a cause but a separate respiratory condition characterized by airway inflammation and hyperresponsiveness. Allergies, choice C, are not a direct cause of COPD but can exacerbate symptoms in individuals with existing COPD. Chronic bronchitis, choice D, is a type of COPD, not a cause of COPD itself, making it an incorrect choice in this context.

2. A nurse is preparing for intershift report when a nurse’s aide pulls an emergency call light in a client’s room. Upon answering the light, the nurse finds a client who returned from surgery earlier in the day experiencing tachycardia and tachypnea. The client’s blood pressure is 88/60 mm Hg. Which action should the nurse take first?

• A. Calling the physician
• B. Checking the hourly urine output
• C. Checking the IV site for infiltration
• D. Placing the client in a modified Trendelenburg position

Correct answer: D

Rationale: The client is exhibiting signs of shock, indicated by tachycardia, tachypnea, and hypotension. Placing the client in a modified Trendelenburg position is the initial action to improve venous return, cardiac output, and subsequently increase blood pressure. This position helps redistribute blood flow to vital organs. Calling the physician should follow once immediate intervention has been initiated. Checking the hourly urine output and IV site are important assessments but are secondary to addressing the client's hemodynamic instability and potential for shock.

3. A client is tested for HIV with the use of an enzyme-linked immunosorbent assay (ELISA), and the test result is positive. The nurse should tell the client that:

• A. HIV infection has been confirmed
• B. The client probably has an opportunistic infection
• C. The test will need to be confirmed with the use of a Western blot
• D. A positive test is a normal result and does not mean that the client is infected with HIV

Correct answer: C

Rationale: When an ELISA test for HIV is positive, it is essential to confirm the result with a Western blot. The Western blot is the confirmatory test for HIV. Choice A is incorrect because a positive ELISA test does not confirm HIV infection. Choice B is incorrect as it assumes a different diagnosis. Choice D is incorrect because a positive ELISA test does indicate potential HIV infection and requires confirmation.

4. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer?

• A. A 25-year-old female with a history of sexually transmitted diseases
• B. A 42-year-old male who has worked in a lumber yard for 10 years
• C. A 55-year-old female who has had numerous episodes of bacterial cystitis
• D. An 86-year-old male with a 50–pack-year cigarette smoking history

Correct answer: D

Rationale: The correct answer is D. The greatest risk factor for bladder cancer is a long history of tobacco use, which is reflected in an 86-year-old male with a 50–pack-year cigarette smoking history. Smoking is a well-established risk factor for developing bladder cancer. Choices A, B, and C are not directly linked to an increased risk of bladder cancer. While sexually transmitted diseases, certain occupational exposures, and recurrent urinary tract infections may pose other health risks, they are not specifically associated with an elevated risk of bladder cancer.

5. In a patient with chronic kidney disease, which of the following is a common electrolyte imbalance?

• A. Hyperkalemia.
• B. Hypokalemia.
• C. Hypernatremia.
• D. Hyponatremia.

Correct answer: A

Rationale: Hyperkalemia is a common electrolyte imbalance in chronic kidney disease. In chronic kidney disease, the kidneys' reduced function leads to the decreased excretion of potassium, resulting in elevated serum potassium levels. This can be dangerous as hyperkalemia can lead to life-threatening arrhythmias. Hypokalemia (Choice B) is less common in chronic kidney disease as the impaired kidneys tend to retain potassium. Hypernatremia (Choice C) is more commonly seen in conditions such as dehydration, not primarily in chronic kidney disease. Hyponatremia (Choice D) is also possible in chronic kidney disease but is less common compared to hyperkalemia.

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