Nursing Elites

1. A client admitted with an episode of bleeding esophageal varices is receiving propranolol (Inderal LA). The nurse knows to monitor for?

• A. Hypertension
• B. Hyperkalemia
• C. Bradycardia
• D. Arthralgia

Correct answer: C

Rationale: The correct answer is 'Bradycardia.' Propranolol is a beta-blocking agent used to decrease the heart rate. In the case of bleeding esophageal varices, propranolol is given to reduce the risk of bleeding by keeping the heart rate around 55 beats per minute. Monitoring for bradycardia is essential as the medication's intended effect is to lower the heart rate. Choices A, B, and D are incorrect because propranolol would not typically cause hypertension, hyperkalemia, or arthralgia.

2. A newborn baby exhibits a reflex that includes hand opening, abducted, and extended extremities following a jarring motion. Which of the following correctly identifies the reflex?

• A. ATNR reflex
• B. Startle reflex
• C. Grasping reflex
• D. Moro reflex

Correct answer: D

Rationale: The Moro reflex, also known as the startle reflex, is the correct answer. This reflex is characterized by the baby's response to a sudden head movement or loud noise, causing them to open their hands, extend their arms, and then bring them back towards their body. The characteristics mentioned in the question - hand opening, abducted, and extended extremities following a jarring motion - align with the Moro reflex. The asymmetrical tonic neck reflex (ATNR) involves the head turning to one side with extension of the same side's arm and leg, not the described characteristics. The grasping reflex involves the baby's response to touch on the palm, causing them to grasp an object. While the Moro reflex is often referred to as the startle reflex due to its response to sudden stimuli, the specific characteristics described in the question match the Moro reflex.

3. When teaching a patient with COPD pulmonary exercises, what should be done?

• A. Teach pursed-lip breathing techniques.
• B. Encourage repetitive heavy lifting exercises to increase strength.
• C. Limit exercises due to respiratory acidosis.
• D. Take breaks every 10-20 minutes during exercises.

Correct answer: A

Rationale: The correct answer is to teach pursed-lip breathing techniques. Pursed-lip breathing helps to decrease the volume of air expelled by keeping the airways open longer, making it easier for patients with COPD to breathe out. Encouraging heavy lifting exercises (Choice B) is not suitable for patients with COPD as it can lead to increased shortness of breath. Limiting exercises due to respiratory acidosis (Choice C) is not correct; instead, exercises should be tailored to the patient's tolerance. Taking breaks every 10-20 minutes (Choice D) is not specific to the management of COPD pulmonary exercises.

4. Which of the following is likely to increase the risk of sexually transmitted disease?

• A. alcohol use
• B. certain types of sexual practices
• C. oral contraception use
• D. all of the above

Correct answer: D

Rationale: All of the above factors are likely to increase the risk of sexually transmitted diseases (STDs). Alcohol use can impair judgment, leading to risky sexual behavior. Certain types of sexual practices, especially unprotected sex or multiple partners, increase the likelihood of contracting STDs. While oral contraception use does not directly increase the risk of STDs, it does not protect against them either. Therefore, all the choices (alcohol use, certain types of sexual practices, and oral contraception use) can contribute to an increased risk of contracting STDs.

5. Which of the following symptoms is most characteristic of a client with lung cancer?

• A. exertional dyspnea
• B. persistent changing cough
• C. air hunger; dyspnea
• D. cough with night sweats

Correct answer: B

Rationale: The most characteristic symptom of lung cancer is a persistent changing cough. This cough may worsen over time and may produce blood-tinged sputum. Exertional dyspnea (Choice A) is more common in chronic obstructive pulmonary disease (COPD) due to airway obstruction. Air hunger and dyspnea (Choice C) are more typical of conditions like asthma. Cough with night sweats (Choice D) is commonly associated with tuberculosis rather than lung cancer.

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