Nursing Elites

1. Which of the following is a key symptom of myocardial infarction (MI)?

• A. Chest pain.
• B. Shortness of breath.
• C. Nausea.
• D. Fatigue.

Correct answer: A

Rationale: The correct answer is A: Chest pain. Chest pain is a hallmark symptom of myocardial infarction (MI) due to inadequate blood flow to the heart muscle. This pain can be severe, crushing, or squeezing, and may radiate to the left arm, jaw, or back. Shortness of breath (choice B), nausea (choice C), and fatigue (choice D) can accompany MI but are not as specific or characteristic as chest pain in diagnosing this condition. Therefore, chest pain is the primary symptom to recognize for suspected MI.

2. A middle-aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?

• A. Test your urine daily for the presence of ketone bodies and proteins.
• B. Use tampons rather than sanitary napkins during your menstrual period.
• C. Drink more water and empty your bladder more frequently during the day.
• D. Keep your hemoglobin A1c under 9% by controlling your blood sugar levels.

Correct answer: C

Rationale: The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

3. A nursing student is suctioning a client through a tracheostomy tube while a nurse observes. Which action by the student would prompt the nurse to intervene and demonstrate the correct procedure? Select all that apply.

• A. Setting the suction pressure to 60 mm Hg
• B. Applying suction throughout the procedure
• C. Assessing breath sounds before suctioning
• D. Placing the client in a supine position before the procedure

Correct answer: A

Rationale: The correct suction pressure for an adult client with a tracheostomy tube is typically between 80 to 120 mm Hg. Suction should be applied intermittently during catheter withdrawal to avoid damaging the airway. Assessing breath sounds before suctioning is important to ensure the procedure is necessary. Placing the client in a supine position before suctioning can compromise their airway; instead, the head of the bed should be elevated to facilitate proper drainage and reduce the risk of aspiration. Therefore, setting the suction pressure to 60 mm Hg is incorrect and would prompt the nurse to intervene and correct the procedure.

4. 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.

5. A client with an oversecretion of renin has a health history reviewed by a nurse. Which disorder should the nurse correlate with this assessment finding?

• A. Alzheimer’s disease
• B. Hypertension
• C. Diabetes mellitus
• D. Viral hepatitis

Correct answer: B

Rationale: Renin is secreted in response to low blood volume, blood pressure, or blood sodium levels. Excessive renin secretion can lead to persistent hypertension. Renin plays no role in Alzheimer's disease, diabetes mellitus, or viral hepatitis. Therefore, the correct correlation with oversecretion of renin is hypertension.

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