Nursing Elites

1. Which of the following lipid abnormalities is a risk factor for the development of atherosclerosis and peripheral vascular disease?

• A. Low concentration of triglycerides.
• B. High levels of high-density lipoprotein (HDL) cholesterol.
• C. High levels of low-density lipoprotein (LDL) cholesterol.
• D. Low levels of LDL cholesterol.

Correct answer: C

Rationale: The correct answer is C: High levels of low-density lipoprotein (LDL) cholesterol. High levels of LDL cholesterol contribute to the development of atherosclerosis and peripheral vascular disease by being deposited in the blood vessel walls, leading to the formation of plaques that can obstruct blood flow. Choice A is incorrect as a low concentration of triglycerides is not typically associated with an increased risk of atherosclerosis or PVD. Choice B is incorrect as high levels of high-density lipoprotein (HDL) cholesterol are actually considered protective against atherosclerosis as it helps remove cholesterol from arteries. Choice D is incorrect as low levels of LDL cholesterol are not typically considered a risk factor for atherosclerosis or PVD.

2. A client with histoplasmosis has the following arterial blood gas (ABG) results: pH 7.30, PCO2 58 mm Hg, PO2 75 mm Hg, HCO3 27 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: A

Rationale: The client's ABG results show a low pH (acidosis) and an elevated PCO2, indicating respiratory acidosis. In respiratory acidosis, there is inadequate excretion of CO2, leading to increased PCO2 levels and a decrease in pH. Therefore, the correct answer is 'Metabolic acidosis'. Choices B, C, and D are incorrect. Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. Respiratory acidosis involves low pH and high PCO2 levels, as seen in this case. Respiratory alkalosis is associated with high pH and low PCO2 levels.

3. A CD4+ lymphocyte count is performed on a client infected with HIV. The results of the test indicate a CD4+ count of 450 cells/L. The nurse interprets this test result as indicating:

• A. Improvement in the client
• B. The need for antiretroviral therapy
• C. The need to discontinue antiretroviral therapy
• D. An effective response to the treatment for HIV

Correct answer: B

Rationale: A CD4+ count of 450 cells/L is below the normal range (500-1600 cells/mcL), indicating a decline in immune function in the client. Antiretroviral therapy is recommended when the CD4+ count falls below 500 cells/mcL or below 25%, or when the client displays symptoms of HIV. Therefore, the interpretation of this test result suggests that the client requires antiretroviral therapy to manage the HIV infection. Choices A, C, and D are incorrect because a CD4+ count of 450 cells/L does not signify improvement, discontinuation of therapy, or an effective response to treatment for HIV.

4. When preparing a client for intravenous pyelography (IVP), which action by the nurse is most important?

• A. Administering a sedative
• B. Encouraging fluid intake
• C. Administering an oral preparation of radiopaque dye
• D. Questioning the client about allergies to iodine or shellfish

Correct answer: D

Rationale: The most crucial action for the nurse when preparing a client for intravenous pyelography (IVP) is to question the client about allergies to iodine or shellfish. Some IVP dyes contain iodine, and if the client is allergic to iodine or shellfish, they may experience severe allergic reactions such as itching, hives, rash, throat tightness, difficulty breathing, or bronchospasm. Administering a sedative (Choice A) may be needed for relaxation during the procedure, encouraging fluid intake (Choice B) is generally beneficial but not the most crucial for IVP preparation, and administering radiopaque dye (Choice C) should only be done after confirming the client's safety regarding allergies to iodine or shellfish.

5. 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.

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