Nursing Elites

1. Which of the following can cause coup-contrecoup injuries?

• A. Rotational forces
• B. Deformation forces
• C. Deceleration forces
• D. Acceleration forces

Correct answer: C

Rationale: Deceleration forces occur when the head is moving and abruptly comes to a stop, such as in a car crash. This sudden deceleration can cause the brain to hit against the skull, resulting in coup-contrecoup injuries. In a coup-contrecoup injury, the brain is damaged on opposite sides due to the initial impact and the rebound effect inside the skull. Rotational forces usually result in diffuse axonal injuries rather than coup-contrecoup injuries. Deformation forces can cause focal brain injuries but not coup-contrecoup injuries. Acceleration forces typically lead to diffuse brain injuries, not coup-contrecoup injuries. Therefore, the correct answer is deceleration forces.

2. To prevent a Valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would:

• A. Assist the client in using the bedside commode.
• B. Administer stool softeners daily as prescribed.
• C. Administer antidysrhythmics prn as ordered.
• D. Maintain the client on strict bed rest.

Correct answer: B

Rationale: Administering stool softeners daily is crucial to prevent straining during defecation, which can lead to the Valsalva maneuver. Straining can increase intrathoracic pressure, decrease venous return to the heart, and reduce cardiac output, potentially worsening the client's condition. If constipation occurs, the use of laxatives may be necessary to avoid straining. Administering antidysrhythmics on an as-needed basis is not indicated for preventing the Valsalva maneuver; they are used to manage dysrhythmias. Strict bed rest is not necessary and may lead to complications such as deconditioning, DVT, and respiratory issues in the absence of specific medical indications.

3. A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance?

• A. Assist the patient to splint the chest when coughing.
• B. Teach the patient about the need for fluid intake.
• C. Encourage the patient to wear the nasal oxygen cannula.
• D. Instruct the patient on the pursed lip breathing technique.

Correct answer: A

Rationale: Assisting the patient to splint the chest when coughing is the most appropriate action to promote airway clearance in a patient with bacterial pneumonia, rhonchi, and thick sputum. Splinting the chest helps reduce pain during coughing and increases the effectiveness of clearing secretions. Teaching the patient about the need for fluid intake is important as it helps liquefy secretions, aiding in easier clearance. Encouraging the patient to wear a nasal oxygen cannula may improve gas exchange but does not directly promote airway clearance. Instructing the patient on the pursed lip breathing technique is beneficial for improving gas exchange in patients with COPD but does not directly aid in airway clearance in a patient with bacterial pneumonia and thick sputum.

4. Signs and symptoms of stroke may include all of the following EXCEPT:

• A. Sudden weakness or numbness of the face, arm, or leg.
• B. Sudden confusion.
• C. Sudden headache with no known cause.
• D. Hypotension.

Correct answer: D

Rationale: Hypotension is not a typical sign or symptom of an acute stroke. The correct signs and symptoms of a stroke include sudden weakness or numbness of the face, arm, or leg, sudden confusion, and a sudden headache with no known cause. Hypotension, which refers to low blood pressure, is not a common indicator of a stroke. It is important to differentiate between hypotension and hypertension in the context of stroke symptoms, as hypertension (high blood pressure) is actually a risk factor for strokes. Sudden weakness, numbness, confusion, and headache are signs associated with a stroke due to a disruption in blood flow to the brain. Hypotension, on the other hand, primarily indicates low blood pressure and is not directly linked to the typical presentation of a stroke.

5. A nurse admits a 3-week-old infant to the special care nursery with a diagnosis of bronchopulmonary dysplasia. As the nurse reviews the birth history, which data would be most consistent with this diagnosis?

• A. Gestational age assessment suggested growth retardation
• B. Meconium was cleared from the airway at delivery
• C. Phototherapy was used to treat Rh incompatibility
• D. The infant received mechanical ventilation for 2 weeks

Correct answer: D

Rationale: The correct answer is 'The infant received mechanical ventilation for 2 weeks.' Bronchopulmonary dysplasia is a condition primarily caused by therapies like positive-pressure ventilation used in the treatment of lung disease. This leads to lung damage and subsequent respiratory problems. Choices A, B, and C are not consistent with the diagnosis of bronchopulmonary dysplasia. Gestational age assessment suggesting growth retardation is more indicative of intrauterine growth restriction, clearing meconium from the airway at delivery is related to potential respiratory issues at birth, and phototherapy for Rh incompatibility is unrelated to bronchopulmonary dysplasia.

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