Nursing Elites

1. Which of the following vascular system changes result from aging?

• A. Increased peripheral resistance of the blood vessels
• B. Decreased blood flow
• C. Increased workload of the left ventricle
• D. All of the above

Correct answer: D

Rationale: As individuals age, various changes occur in the vascular system. These changes include increased peripheral resistance of the blood vessels, decreased blood flow, and an increased workload of the left ventricle. Therefore, all the listed changes result from aging, making option D, 'All of the above,' the correct answer.

2. What is the most appropriate nursing order for a patient who develops dyspnea and shortness of breath?

• A. Maintain the patient on strict bed rest at all times
• B. Maintain the patient in an orthopneic position as needed
• C. Administer high-flow oxygen immediately
• D. Encourage the patient to engage in vigorous physical activity

Correct answer: B

Rationale: Maintaining the patient in an orthopneic position as needed is the most appropriate nursing order for a patient experiencing dyspnea and shortness of breath. This position helps to optimize lung expansion, improve oxygenation, and alleviate breathing difficulties. It is a strategic intervention to enhance respiratory function in patients with respiratory distress. Choice A is incorrect because strict bed rest may not address the underlying respiratory issue effectively. Choice C is premature as administering high-flow oxygen should be based on a comprehensive assessment. Choice D is inappropriate as encouraging vigorous physical activity can exacerbate breathing problems in a patient experiencing dyspnea.

3. A healthcare provider is caring for an adolescent who has sickle-cell anemia. Which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider?

• A. Substernal retractions
• B. Hematuria
• C. Temperature 37.9�C (100.2�F)
• D. Sneezing

Correct answer: A

Rationale: Substernal retractions are a concerning sign of respiratory distress and can indicate acute chest syndrome, a severe complication of sickle-cell anemia. It results from vaso-occlusion in the pulmonary vasculature, leading to impaired oxygenation. Prompt reporting of this symptom is crucial for early intervention to prevent further complications. Hematuria, a high temperature, and sneezing are not specific manifestations of acute chest syndrome and would not warrant immediate notification to the provider in this context.

4. Which of the following statements about chest X-rays is false?

• A. There are contraindications for this test
• B. Before the procedure, the patient should remove all jewelry, metallic objects, and buttons above the waist
• C. A signed consent is not required
• D. Eating, drinking, and medications are allowed before this test

Correct answer: A

Rationale: The correct answer is A because there are contraindications for chest X-rays, such as pregnancy or concerns about radiation exposure. Patients may need to remove jewelry and metallic objects to prevent interference with the imaging. While a signed consent is typically not required for a routine chest X-ray, there are specific situations where consent may be necessary. It is essential for patients to follow fasting instructions before certain types of chest X-rays to obtain accurate results.

5. A client in labor is receiving oxytocin. Which of the following findings indicates that the nurse should increase the rate of infusion?

• A. Urine output of 20 ml/hr.
• B. Montevideo units constantly at 300 mm Hg.
• C. FHR pattern showing absent variability.
• D. Contractions occurring every 5 minutes and lasting 30 seconds.

Correct answer: B

Rationale: Montevideo units measure the strength and frequency of contractions during labor. A consistent Montevideo units reading of 300 mm Hg or higher is indicative of effective uterine contractions. In this scenario, an increase in the rate of oxytocin infusion may be warranted to further augment contractions and promote progress in labor. The other options, such as low urine output, absent variability in fetal heart rate, and short contractions, do not directly correlate with the need for an increase in oxytocin infusion rate.

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