Nursing Elites

1. A client presents at a community-based clinic with complaints of shortness of breath, headache, dizziness, and nausea. During the assessment, the nurse learns that the client is a migrant worker who often uses a gasoline-powered pressure washer to clean equipment and farm buildings. Which type of poisoning is the most likely etiology of this client's symptoms?

• A. asbestos
• B. silica dust
• C. histoplasmosis
• D. carbon monoxide

Correct answer: D

Rationale: The client's symptoms of shortness of breath, headache, dizziness, and nausea are indicative of carbon monoxide poisoning, which can result from exposure to gasoline-powered equipment like pressure washers. Asbestos (Choice A) exposure would typically present with respiratory issues and cancer but not the rapid onset of symptoms described. Silica dust (Choice B) exposure is associated with respiratory conditions like silicosis, not the multisystem symptoms in the scenario. Histoplasmosis (Choice C) is a fungal infection that primarily affects the lungs and is not related to the client's exposure to a gasoline-powered pressure washer.

2. A person with no known illness whose daily routine consists of walking and following a healthy diet would be best characterized as engaging in which kind of activities?

• A. health balance
• B. disease prevention
• C. health promotion
• D. self-fulfillment

Correct answer: C

Rationale: The correct answer is C: health promotion. Health promotion activities involve maintaining a healthy lifestyle to prevent illness. In this scenario, the person is actively engaging in behaviors that promote their overall health and well-being, such as walking and following a healthy diet. Choice A, 'health balance,' is vague and does not specifically address the proactive nature of the person's actions. Choice B, 'disease prevention,' while related, focuses more on specific actions taken to prevent diseases rather than the broader concept of promoting overall health. Choice D, 'self-fulfillment,' does not directly relate to the activities described in the question.

3. A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse should monitor the client for which of the following side effects?

• A. Constipation
• B. Hypertension
• C. Muscle weakness
• D. Bradycardia

Correct answer: D

Rationale: The correct answer is D: Bradycardia. Pyridostigmine, a cholinesterase inhibitor used in myasthenia gravis, can lead to bradycardia as a side effect. Choice A, constipation, is not a common side effect of pyridostigmine. Choice B, hypertension, is unlikely as pyridostigmine is more likely to cause hypotension. Choice C, muscle weakness, is actually a symptom of myasthenia gravis itself and not a side effect of pyridostigmine.

4. As a client who is terminally ill has been receiving high doses of an opioid analgesic for the past month and becomes unresponsive to verbal stimuli as death approaches, what orders would the nurse expect from the healthcare provider?

• A. Decrease the analgesic dosage by half
• B. Discontinue the analgesic
• C. Continue the same analgesic dosage
• D. Prescribe a less potent drug

Correct answer: C

Rationale: Continuing the same dosage of analgesic is appropriate to manage pain effectively as death nears and the client becomes unresponsive. The primary goal of palliative care in end-of-life situations is to ensure comfort, regardless of the client's level of consciousness. Decreasing the analgesic dosage or discontinuing it could lead to inadequate pain relief, which goes against the principles of palliative care. Prescribing a less potent drug may also compromise pain management in this critical stage. Therefore, maintaining the same analgesic dosage is the most appropriate action to provide comfort and alleviate suffering.

5. Which of the following measures the risk of dying from causes related to pregnancy, childbirth, and puerperium?

• A. maternal mortality
• B. neonatal death rate
• C. fetal death rate
• D. infant mortality rate

Correct answer: A

Rationale: The correct answer is A, maternal mortality. Maternal mortality specifically measures the risk of dying from pregnancy-related causes. Neonatal death rate, fetal death rate, and infant mortality rate focus on different populations and timeframes. Neonatal death rate refers to deaths within the first 28 days of life, fetal death rate measures stillbirths, and infant mortality rate includes deaths of infants under one year of age. Therefore, A is the most appropriate measure for assessing the risk of dying from causes related to pregnancy, childbirth, and puerperium.

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