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 client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 62, PaCO2 59, and HCO3. Which statement describes the most likely cause of the simultaneous increase in both the PaO2 and the PaCO2?

• A. The hypercapnia resulted from the rapid respirations.
• B. The hypoxic drive was reduced by the oxygen therapy.
• C. The client had a pneumothorax which restricted ventilation.
• D. The client had a pulmonary embolism that reduced perfusion.

Correct answer: B

Rationale: In patients with COPD, oxygen therapy can reduce the hypoxic drive, which is the primary stimulus for breathing in these individuals. By providing supplemental oxygen, the hypoxic drive is diminished, resulting in decreased respiratory effort. As a consequence, the PaO2 may increase due to the supplemental oxygen, but this can lead to a decrease in the respiratory drive and subsequent retention of carbon dioxide, causing an increase in PaCO2 levels. Option A is incorrect because rapid respirations would typically lower PaCO2 levels. Option C is incorrect as a pneumothorax would lead to impaired gas exchange and decreased PaO2 levels without necessarily affecting PaCO2 levels. Option D is incorrect as a pulmonary embolism would typically result in ventilation-perfusion mismatch and decreased PaO2 levels without directly impacting PaCO2 levels.

3. After a myocardial infarction, why is the hospitalized client taught to move the legs while resting in bed?

• A. Prepare the client for ambulation.
• B. Promote urinary and intestinal elimination.
• C. Prevent thrombophlebitis and blood clot formation.
• D. Decrease the likelihood of pressure ulcer formation.

Correct answer: C

Rationale: The correct answer is C. Moving the legs helps prevent thrombophlebitis and blood clot formation by promoting venous return in clients on bed rest. This prevents stasis and clot formation in the lower extremities. Choices A, B, and D are incorrect because the primary goal of moving the legs is to prevent thrombophlebitis and blood clot formation, rather than preparing for ambulation, promoting elimination, or decreasing pressure ulcer formation. Ambulation preparation involves different exercises, urinary and intestinal elimination are not directly related to leg movements, and pressure ulcer prevention is more related to repositioning and skin care.

4. The nurse is caring for a client with chronic renal failure who is on a low-potassium diet. Which of the following foods should the client avoid?

• A. Bananas
• B. Potatoes
• C. Rice
• D. Apples

Correct answer: A

Rationale: Bananas are high in potassium content, which can lead to hyperkalemia in clients with chronic renal failure who are on a low-potassium diet. Therefore, it is crucial for these clients to avoid bananas. Potatoes, rice, and apples are lower in potassium compared to bananas and are generally considered safe for consumption in clients with chronic renal failure on a low-potassium diet.

5. Four days following an abdominal aortic aneurysm repair, the client is exhibiting edema of both lower extremities, and pedal pulses are not palpable. Which action should the nurse implement first?

• A. Elevate extremities on pillows
• B. Evaluate edema for pitting
• C. Assess pulses with a vascular Doppler
• D. Wrap the feet with warmed blankets

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to assess pulses with a vascular Doppler. The absence of palpable pedal pulses following an abdominal aortic aneurysm repair raises concerns about compromised blood flow, which could lead to serious complications like ischemia or thrombosis. Evaluating and confirming the presence or absence of pulses is crucial to guide further interventions. Elevating extremities on pillows (Choice A) may be beneficial for managing edema, but it is not the immediate priority when pulses are not palpable. Evaluating edema for pitting (Choice B) can provide additional information about fluid status but does not address the primary concern of absent pulses. Wrapping the feet with warmed blankets (Choice D) is not appropriate in this situation and may not address the underlying vascular issue.

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