Nursing Elites

1. Why is the combination drug trimethoprim-sulfamethoxazole (TMP-SMX) necessary?

• A. To broaden the antibacterial spectrum.
• B. To decrease bacterial resistance.
• C. To improve the taste.
• D. To minimize toxic effects.

Correct answer: B

Rationale: The correct answer is B: To decrease bacterial resistance. Trimethoprim-sulfamethoxazole (TMP-SMX) is a combination drug used to prevent bacterial resistance to sulfonamides. It works by targeting different steps in the bacterial metabolic pathway, making it harder for bacteria to develop resistance. Choice A is incorrect because the combination does not broaden the antibacterial spectrum; instead, it enhances effectiveness against specific bacteria. Choice C is incorrect as taste improvement is not the primary reason for combining these drugs. Choice D is incorrect because while combination therapy can sometimes help minimize toxic effects, the primary purpose in this case is to address bacterial resistance.

2. In the change-of-shift report, the nurse is told that a client has a Stage 2 pressure ulcer. Which ulcer appearance is most likely to be observed?

• A. Shallow open ulcer with a red-pink wound bed.
• B. A deep pocket of infection and necrotic tissues.
• C. An area of erythema that is painful to touch.
• D. Visible subcutaneous tissue with sloughing.

Correct answer: A

Rationale: A Stage 2 pressure ulcer typically presents as a shallow open ulcer with a red-pink wound bed. This appearance is characteristic of a Stage 2 pressure ulcer where there is partial thickness skin loss involving the epidermis and possibly the dermis. Choice B, a deep pocket of infection and necrotic tissues, is more indicative of a Stage 3 or Stage 4 pressure ulcer where the ulcer extends into deeper tissue layers. Choice C, an area of erythema that is painful to touch, is more commonly seen in early-stage pressure ulcers such as Stage 1. Choice D, visible subcutaneous tissue with sloughing, is characteristic of a more severe stage of pressure ulcer beyond Stage 2.

3. A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestations? (Select all that apply.)

• A. Stress incontinence – Urine loss with physical exertion
• B. Urge incontinence – Large amount of urine with each occurrence
• C. Overflow incontinence – Constant dribbling of urine
• D. All of the above

Correct answer: D

Rationale: The correct answer is D, as all the choices are correctly paired with their clinical manifestations. Stress incontinence is characterized by urine loss with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with a sudden and strong urge to void, often accompanied by a large amount of urine released during each occurrence. Overflow incontinence occurs when the bladder is distended, leading to a constant dribbling of urine. Functional incontinence, not mentioned in the options, is the leakage of urine due to factors unrelated to a lower urinary tract disorder. Reflex incontinence, also not mentioned, is a condition resulting from abnormal detrusor contractions.

4. A healthcare professional is reading the chest x-ray report of a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. The healthcare professional interprets that the tube is positioned above:

• A. The first tracheal cartilaginous ring
• B. The point where the larynx connects to the trachea
• C. The bifurcation of the right and left main stem bronchi
• D. The area connecting the oropharynx to the laryngopharynx

Correct answer: C

Rationale: The carina is a cartilaginous ridge that separates the openings of the two main stem (right and left) bronchi. If an endotracheal tube is inserted past the carina, the tube will enter the right main stem bronchus due to the natural curvature of the airway. This positioning is dangerous as only the right lung will be ventilated. It can be identified as only the right lung will have breath sounds and rise and fall with ventilation. Choices A, B, and D are incorrect as they do not relate to the specific anatomical landmark mentioned in the scenario.

5. The healthcare provider is assessing a client with chronic renal failure who is receiving hemodialysis. Which of the following findings would indicate that the client is experiencing a complication of the treatment?

• A. Clear dialysate outflow.
• B. Blood pressure of 150/90 mm Hg.
• C. Increased heart rate.
• D. Fatigue.

Correct answer: B

Rationale: A blood pressure of 150/90 mm Hg during hemodialysis may indicate fluid overload or an ineffective dialysis session, which can lead to complications such as heart failure or pulmonary edema. This finding should be reported promptly for further evaluation and intervention. Clear dialysate outflow is a normal and expected finding during hemodialysis, indicating proper filtration of waste products. Increased heart rate can be a normal compensatory response to hemodialysis due to fluid shifts and should be monitored but does not necessarily indicate a complication. Fatigue is a common symptom in clients with chronic renal failure undergoing hemodialysis and is not specific to complications of the treatment.

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