Nursing Elites

1. Which statement best conveys an aspect of the role of cerebrospinal fluid (CSF)?

• A. CSF provides immune protection to the brain and spinal cord by serving as a physical barrier.
• B. CSF cushions the brain and spinal cord, protecting them from injury.
• C. CSF plays a limited role in the exchange of nutrients and waste products between the blood and brain.
• D. CSF functions primarily as a medium for the transmission of nerve impulses.

Correct answer: B

Rationale: The correct answer is B. Cerebrospinal fluid primarily cushions the brain and spinal cord, protecting them from injury. Choice A is incorrect because while CSF contributes to the brain's immune environment, its main role is not providing immune protection as a physical barrier. Choice C is incorrect because CSF has a significant role in the exchange of nutrients and waste products, rather than a limited one. Choice D is incorrect as CSF is not primarily a medium for nerve impulse transmission, but rather serves as a protective and supportive fluid.

2. What key contraindication should the nurse emphasize to a patient prescribed sildenafil (Viagra) for erectile dysfunction?

• A. Sildenafil is contraindicated in patients taking nitrates due to the risk of severe hypotension.
• B. Sildenafil should not be taken with food as it can reduce its effectiveness.
• C. Sildenafil is contraindicated in patients with a history of hypertension.
• D. Sildenafil should not be taken with grapefruit juice as it can lead to dangerous side effects.

Correct answer: A

Rationale: The correct answer is A. Sildenafil is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, leading to a synergistic effect that can result in a dangerous drop in blood pressure. Choices B, C, and D are incorrect because there is no specific contraindication for taking sildenafil with food, having a history of hypertension, or taking it with grapefruit juice. The main concern is the concurrent use of nitrates with sildenafil.

3. A 65-year-old man is admitted to the intensive care unit from the operating room after a triple coronary artery bypass graft. He is intubated and on a ventilator. Lactic acid levels were normal postoperatively, but now they are rising. The increased level could be an indication of:

• A. excessive sedation
• B. bowel ischemia
• C. excessive volume infusion in the operating room
• D. mild hypothermia postoperatively

Correct answer: B

Rationale: In this scenario, the rising lactic acid levels in a 65-year-old man after a coronary artery bypass graft could indicate bowel ischemia. Bowel ischemia can lead to anaerobic metabolism, causing an increase in lactic acid levels. Excessive sedation may cause respiratory depression but would not directly lead to rising lactic acid levels. Excessive volume infusion in the operating room might cause fluid overload but would not typically result in rising lactic acid levels. Mild hypothermia postoperatively could lead to shivering and increased oxygen consumption, but it is less likely to be the primary cause of rising lactic acid levels in this context.

4. A nursing student having trouble moving her head from side to side is likely experiencing a problem with which type of neurons?

• A. General visceral efferent neurons
• B. Preganglionic neurons
• C. Parasympathetic postganglionic neurons
• D. Pharyngeal efferent neurons

Correct answer: D

Rationale: The correct answer is D: Pharyngeal efferent neurons. Pharyngeal efferent neurons are responsible for controlling head movements, including side-to-side motions. General visceral efferent neurons (Choice A) are involved in innervating smooth muscles and glands in the body's internal organs. Preganglionic neurons (Choice B) are part of the autonomic nervous system and connect the central nervous system to the ganglia. Parasympathetic postganglionic neurons (Choice C) are the second neurons in the parasympathetic nervous system pathway, responsible for innervating target organs. In this case, the issue with moving the head from side to side indicates a problem with the pharyngeal efferent neurons.

5. A child with a serious fungal infection is receiving amphotericin B parenterally. Which of the following minerals will the patient most likely be required to receive?

• A. Chloride
• B. Magnesium
• C. Glucose
• D. Sodium

Correct answer: B

Rationale: When a patient is receiving amphotericin B, which is known to cause renal toxicity, they are most likely to require magnesium supplementation. Amphotericin B can lead to renal loss of magnesium, potassium, and calcium. Magnesium is an essential mineral that plays a vital role in various physiological functions, and its levels need to be monitored and supplemented when necessary. Chloride, glucose, and sodium are not typically supplemented in the context of amphotericin B therapy for a serious fungal infection.

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