Nursing Elites

1. A client with a history of rheumatic fever presents with signs of heart failure. What is the likely underlying cause?

• A. Infective endocarditis
• B. Coronary artery disease
• C. Mitral valve stenosis
• D. Aortic regurgitation

Correct answer: C

Rationale: The correct answer is C: Mitral valve stenosis. Rheumatic fever can lead to scarring and thickening of the heart valves, often affecting the mitral valve. This stenosis can impede blood flow from the left atrium to the left ventricle, eventually causing heart failure. Choice A, infective endocarditis, is an infection of the endocardium, the inner lining of the heart chambers and valves, and is not directly related to rheumatic fever. Choice B, coronary artery disease, involves the obstruction of coronary arteries supplying the heart muscle with blood, leading to ischemia and not typically associated with rheumatic fever. Choice D, aortic regurgitation, is the backflow of blood from the aorta to the left ventricle and is not a common consequence of rheumatic fever.

2. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which component of his 'white matter' has most likely been damaged?

• A. The inner layer (archilayer)
• B. The middle layer (paleolayer)
• C. The outer layer (neolayer)
• D. The reticular formation

Correct answer: C

Rationale: The correct answer is C: The outer layer (neolayer). The white matter of the spinal cord consists of three layers: the outer layer (neolayer), the middle layer (paleolayer), and the inner layer (archilayer). Damage to the outer layer (neolayer) is likely to affect fine motor skills, explaining the loss of fine motor function in the finger and thumb while gross motor movements remain intact. Choices A, B, and D are incorrect as they do not correspond to the specific layer of the white matter that is typically associated with fine motor control.

3. Which condition is characterized by a lack of antidiuretic hormone (ADH)?

• A. Diabetes mellitus
• B. Diabetes insipidus
• C. Cushing's disease
• D. Hyperthyroidism

Correct answer: B

Rationale: The correct answer is B, Diabetes insipidus. Diabetes insipidus is characterized by a lack of antidiuretic hormone (ADH), leading to excessive urination and thirst. Choice A, Diabetes mellitus, is a different condition characterized by high blood sugar levels. Choice C, Cushing's disease, is caused by prolonged exposure to high levels of cortisol. Choice D, Hyperthyroidism, involves an overactive thyroid gland producing excess thyroid hormones.

4. Which of the following types of vitamin or mineral deficiency can cause megaloblastic anemia and is associated with lower extremity paresthesias?

• A. Vitamin B12
• B. Folate
• C. Iron
• D. Vitamin K

Correct answer: A

Rationale: The correct answer is Vitamin B12. Vitamin B12 deficiency can lead to megaloblastic anemia and neurological symptoms, including lower extremity paresthesias. Folate deficiency can also cause megaloblastic anemia but typically does not present with neurological symptoms. Iron deficiency leads to microcytic anemia, not megaloblastic anemia. Vitamin K deficiency is associated with coagulation abnormalities, not megaloblastic anemia.

5. In the ICU setting, a client transported from surgery following open heart bypass grafting will likely have his or her core temperature measured by:

• A. oral thermometer.
• B. rectal thermometer.
• C. esophageal thermometer.
• D. temporal artery thermometer.

Correct answer: C

Rationale: An esophageal thermometer is commonly used in ICU settings to accurately measure core body temperature, especially in post-surgical patients. The esophageal thermometer provides a more precise measurement of core temperature compared to other methods like oral, rectal, or temporal artery thermometers. In the ICU, accuracy in temperature measurement is crucial for detecting and responding to changes promptly, making the esophageal thermometer the preferred choice in this scenario.

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