Nursing Elites

1. What are the expected manifestations in a patient experiencing a thrombotic stroke?

• A. Sudden numbness or loss of function on one side of the body
• B. Sudden loss of consciousness and seizure
• C. Gradual onset of difficulty speaking
• D. Loss of sensation in the affected limb

Correct answer: A

Rationale: The correct manifestation in a patient experiencing a thrombotic stroke is sudden numbness or loss of function on one side of the body. This is due to the blockage of a blood vessel by a clot, leading to a lack of blood flow to a specific part of the brain. Choices B, C, and D are incorrect. Sudden loss of consciousness and seizure are more commonly associated with hemorrhagic strokes. Gradual onset of difficulty speaking is often seen in ischemic strokes affecting language areas, not specifically in thrombotic strokes. Loss of sensation in the affected limb is more indicative of sensory nerve damage rather than the motor deficits seen in thrombotic strokes.

2. A nurse is teaching a client who has hypertension about dietary modifications to help control blood pressure. Which of the following food choices should the nurse recommend as the best choice for the client to include in their diet?

• A. 1 packet of reconstituted dry onion soup
• B. 3 oz of lean cured ham
• C. 3 oz of chicken breast
• D. ½ cup of canned baked beans

Correct answer: C

Rationale: For a client with hypertension, a low sodium diet is recommended to help control blood pressure. Among the food choices provided, the best option is 3 oz of chicken breast. Chicken breast is lean protein with lower sodium content compared to other choices. It is a healthier option for managing hypertension. Reconstituted dry onion soup (Choice A) and canned baked beans (Choice D) typically contain higher amounts of sodium, which can be detrimental for blood pressure management. Lean cured ham (Choice B) also tends to have a higher sodium content, making it less suitable for a client with hypertension.

3. A nurse is caring for a client who has a traumatic brain injury. Which of the following findings should indicate to the nurse the need for immediate intervention?

• A. Axillary temperature 37.2°C (99°F)
• B. Apical pulse 100/min
• C. Respiratory rate 30/min
• D. Blood pressure 140/84 mm Hg

Correct answer: C

Rationale: The correct answer is C. The nurse should prioritize airway and breathing in a client with a traumatic brain injury. An increased respiratory rate may indicate CO2 retention, which could lead to increased intracranial pressure. Choice A, axillary temperature 37.2°C (99°F), is within normal range and does not indicate an immediate need for intervention. Choice B, apical pulse 100/min, is slightly elevated but not as critical as respiratory distress in this scenario. Choice D, blood pressure 140/84 mm Hg, is also within normal limits and does not require immediate intervention compared to the respiratory rate.

4. What is the first nursing action for a patient admitted with chest pain from acute coronary syndrome?

• A. Administer sublingual nitroglycerin
• B. Check the patient's urine output
• C. Administer IV fluids
• D. Obtain cardiac enzymes

Correct answer: A

Rationale: The correct answer is to administer sublingual nitroglycerin. This is the priority action for a patient admitted with chest pain from acute coronary syndrome. Nitroglycerin helps dilate blood vessels, improve blood flow to the heart, and relieve chest pain. Checking the patient's urine output (Choice B) is not the priority in this situation. Administering IV fluids (Choice C) may not be necessary unless indicated by the patient's condition. Obtaining cardiac enzymes (Choice D) is important but is not the initial action needed to address the patient's acute symptoms.

5. What is the preferred electrical intervention for a patient with ventricular tachycardia with a pulse?

• A. Synchronized cardioversion
• B. Defibrillation
• C. Pacing
• D. Medication administration

Correct answer: A

Rationale: The correct answer is A: Synchronized cardioversion. In ventricular tachycardia with a pulse, synchronized cardioversion is the preferred electrical intervention. Synchronized cardioversion is used to treat tachyarrhythmias where there is a pulse present. Defibrillation (choice B) is used in emergencies for pulseless ventricular tachycardia or ventricular fibrillation. Pacing (choice C) is more suitable for bradycardias or certain conduction abnormalities. Medication administration (choice D) may be used in stable cases or as an adjunct to other treatments, but synchronized cardioversion is the primary intervention for ventricular tachycardia with a pulse.

Similar Questions