Nursing Elites

1. A client is brought to the emergency department after a motor vehicle accident in which she suffered a spinal cord injury at the level of C5. Which of the following assessments should be the priority?

• A. Monitoring urinary output
• B. Monitoring heart rate and rhythm
• C. Monitoring respiratory rate
• D. Monitoring the client's pain levels

Correct answer: B

Rationale: The correct answer is monitoring heart rate and rhythm. With a C5 spinal cord injury, monitoring heart rate and rhythm is crucial as it can impact autonomic regulation. This level of injury can affect cardiac function due to the disruption of sympathetic nerve fibers. Monitoring urinary output may be important to assess for urinary retention, but it is not the priority in this scenario. While monitoring respiratory rate is essential in all patients, in this case, cardiovascular stability takes precedence. Pain management is important but is not the priority when assessing a client with a C5 spinal cord injury.

2. When assessing a patient experiencing breakthrough bleeding while taking oral contraceptives, what should the nurse consider?

• A. The possibility of pregnancy
• B. The patient's adherence to the medication schedule
• C. The need for an increased dosage
• D. The effectiveness of the current oral contraceptive

Correct answer: B

Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, it is crucial for the nurse to consider the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of missed doses or inconsistent use, which can decrease the effectiveness of the oral contraceptive. Considering the possibility of pregnancy (Choice A) is important but secondary to assessing adherence. The need for an increased dosage (Choice C) is not typically the first consideration for breakthrough bleeding. Evaluating the effectiveness of the current oral contraceptive (Choice D) is relevant but should come after assessing adherence to the medication schedule.

3. Which of the following accurately describes the pathophysiology of asthma?

• A. Chronic inflammation of the bronchial lining
• B. Narrowing of the airway due to bronchoconstriction
• C. Damage to alveoli reducing lung elasticity
• D. Overproduction of mucus by the goblet cells

Correct answer: B

Rationale: The correct answer is B: "Narrowing of the airway due to bronchoconstriction." In asthma, there is an inflammatory response that leads to bronchoconstriction, causing the airways to narrow and making it difficult to breathe. Choice A is incorrect as chronic inflammation is a feature of asthma but not the primary pathophysiological mechanism. Choice C is incorrect as damage to alveoli is more characteristic of conditions like emphysema. Choice D is incorrect as overproduction of mucus is a feature of chronic bronchitis, not asthma.

4. Which of the following outcome criteria is appropriate for a client with dementia?

• A. The client will return to an established schedule for activities of daily living.
• B. The client will learn new coping mechanisms to handle anxiety.
• C. The client will seek out resources in the community for support.
• D. The client will follow an established schedule for activities of daily living.

Correct answer: D

Rationale: The correct answer is D. For clients with dementia, following an established schedule for activities of daily living is appropriate as it helps maintain routine and structure, which can be beneficial for their condition. Choice A has been rephrased to align better with the context of dementia care. Choice A is incorrect as expecting a return to a previous level of self-functioning may not be realistic for clients with dementia. Choice B is not the most appropriate outcome criteria as handling anxiety, while important, may not be the primary focus when working with clients with dementia. Choice C, seeking out resources in the community for support, is also important but may not be as directly related to the day-to-day care and management of activities for a client with dementia.

5. A patient with erectile dysfunction is prescribed sildenafil (Viagra). What condition would contraindicate the use of this medication?

• A. History of hypertension
• B. Use of nitrates
• C. Recent use of antihypertensive medications
• D. History of peptic ulcer disease

Correct answer: B

Rationale: The correct answer is B: 'Use of nitrates.' Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, and their combined use can lead to a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of hypertension, recent use of antihypertensive medications, or a history of peptic ulcer disease are not direct contraindications for using sildenafil.

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