Nursing Elites

1. Which of the following situations warrants a measurement for orthostatic hypotension?

• A. A 36-year-old male with a spinal injury
• B. An 86-year-old female with significantly altered mental status
• C. A 58-year-old female with near-syncope
• D. A 41-year-old male with acute deep vein thrombosis

Correct answer: C

Rationale: The correct answer is a 58-year-old female with near-syncope. Orthostatic hypotension is a drop in blood pressure of greater than 20 mmHg systolic when moving from a sitting or lying position to standing. Patients at higher risk include those with syncope or near-syncope, symptomatic hypovolemia, and those prone to falls. The other choices are less likely to present with orthostatic hypotension. A spinal injury, altered mental status, and acute deep vein thrombosis are not directly associated with the immediate need for orthostatic hypotension measurement.

2. A patient in the cardiac unit is concerned about the risk factors associated with atherosclerosis. Which of the following are hereditary risk factors for developing atherosclerosis?

• A. Family history of heart disease
• B. Overweight
• C. Smoking
• D. Age

Correct answer: A

Rationale: A family history of heart disease is an inherited risk factor for developing atherosclerosis. This factor is not modifiable through lifestyle changes. Studies have shown that having a first-degree relative with heart disease significantly increases the individual's risk of developing atherosclerosis. Overweight, smoking, and age are not hereditary risk factors for atherosclerosis. Overweight and smoking are lifestyle-related risk factors, while age is a non-modifiable risk factor that increases with time but is not directly inherited.

3. A patient with Addison's disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is not recommended?

• A. A diet high in grains
• B. A diet with adequate caloric intake
• C. A high protein diet
• D. A restricted sodium diet

Correct answer: D

Rationale: For a patient with Addison's disease, a restricted sodium diet is not recommended. These patients require normal dietary sodium to prevent excess fluid loss. Patients with primary adrenal insufficiency (Addison disease) should have ample access to salt because of the salt wasting that occurs if their condition is untreated. Therefore, a diet high in grains, a diet with adequate caloric intake, and a high protein diet are all recommended for patients with Addison's disease to support their nutritional needs and overall health. However, restricting sodium can be detrimental for these patients due to the nature of their condition.

4. Mrs. O is seen for follow-up after an episode of acute pancreatitis. Her physician orders a serum amylase level and the result is 200 U/L. Which of the following is a potential cause of this result?

• A. The client is pregnant
• B. The client has hypertension
• C. The client is in renal failure
• D. The client has pancreatitis

Correct answer: D

Rationale: An elevated serum amylase level after pancreatitis may indicate another attack of the condition. It is common to order serum amylase as part of routine follow-up after pancreatitis. Elevated levels can also be seen in related gastrointestinal conditions like cholecystitis or an intestinal blockage. Therefore, in this case, the most likely cause of the elevated serum amylase level is a recurrence or ongoing pancreatitis. The other options, including pregnancy, hypertension, and renal failure, are not typically associated with an elevated serum amylase level in the context of follow-up after acute pancreatitis.

5. When escorting a patient to the operating room on a stretcher, what should you do to prevent the patient from falling?

• A. Ensure the safety belt or strap is secured on the patient while escorting them to the operating room
• B. Use a safety belt or strap on the patient throughout their escort to the operating room
• C. Lower the bed position when moving the patient from the bed to the stretcher
• D. All of the above options are correct

Correct answer: B

Rationale: When escorting a patient to the operating room on a stretcher, it is crucial to secure a safety belt or strap on the patient to prevent falls during the transfer. This safety measure is not considered a restraint but a necessary precaution. Lowering the bed position is not necessary; in fact, the bed should be in a high position to align with the stretcher. Locking the wheels of the stretcher is essential to prevent accidents during patient transfer. Therefore, the correct action to prevent falls while moving a patient to the operating room is to use a safety belt or strap on the patient throughout the escort.

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