Nursing Elites

1. A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?

• A. Atherosclerosis
• B. Diabetic nephropathy
• C. Autonomic neuropathy
• D. Somatic neuropathy

Correct answer: C

Rationale: In this case, the correct answer is autonomic neuropathy. Autonomic neuropathy affects the autonomic nerves, which control various bodily functions including the bladder. In diabetes, it can lead to bladder paralysis, resulting in symptoms like urgency to urinate and difficulty initiating urination. Atherosclerosis (choice A) is a condition involving the hardening and narrowing of arteries, not directly related to the inability to urinate in this context. Diabetic nephropathy (choice B) primarily affects the kidneys, leading to kidney damage, but does not typically cause urinary retention. Somatic neuropathy (choice D) involves damage to sensory nerves, not the autonomic nerves responsible for bladder control, making it less likely to be the cause of the urinary issue described in the question.

2. A systolic blood pressure of 145 mm Hg is classified as:

• A. Normotensive
• B. Prehypertension
• C. Stage I hypertension
• D. Stage II hypertension

Correct answer: C

Rationale: A systolic blood pressure of 145 mm Hg falls within the range of 140-159 mm Hg, which is classified as Stage I hypertension. Normotensive individuals have a systolic blood pressure less than 120 mm Hg, making choice A incorrect. Prehypertension is characterized by a systolic blood pressure ranging from 120-139 mm Hg, excluding choice B. Stage II hypertension is diagnosed when the systolic blood pressure is greater than 160 mm Hg, making choice D incorrect. Therefore, the correct classification for a systolic blood pressure of 145 mm Hg is Stage I hypertension.

3. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq potassium chloride in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued?

• A. Narrowed QRS complex
• B. Shortened "PR"? interval
• C. Tall peaked "T"? waves
• D. Prominent "U"? waves

Correct answer: C

Rationale: A tall peaked T wave is a characteristic EKG pattern associated with hyperkalemia. Hyperkalemia refers to high levels of potassium in the blood, which can lead to cardiac arrhythmias and other serious complications. Tall peaked T waves are a red flag for potential cardiac issues and can indicate the need to discontinue potassium infusions. The other choices, such as narrowed QRS complex, shortened "PR"? interval, and prominent "U"? waves, are not typically associated with hyperkalemia. Therefore, recognizing tall peaked T waves is crucial for the nurse to take prompt action in managing the client's condition.

4. The parents of a newborn have been told that their child was born with bladder exstrophy, and the parents ask the nurse about this condition. Which explanation, given by the parents, indicates understanding of this condition?

• A. ''It's a hereditary disorder that occurs in every other generation.''
• B. ''It is caused by the use of medications taken by the mother during pregnancy.''
• C. ''It is a condition in which the urinary bladder is abnormally located in the pelvic cavity.''
• D. ''It's an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall.''

Correct answer: D

Rationale: Bladder exstrophy is a congenital anomaly characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause of bladder exstrophy is not precisely known, but it is believed to be due to a developmental abnormality during embryogenesis. The condition is more common in male newborns. Choice A is incorrect as bladder exstrophy is not a hereditary disorder that occurs in every other generation. Choice B is incorrect as bladder exstrophy is not caused by medications taken by the mother during pregnancy. Choice C is incorrect as it describes the condition inaccurately; it is not just an abnormal location of the bladder in the pelvic cavity, but rather an extrusion of the bladder outside the body through a defect in the lower abdominal wall.

5. Which of the following interventions should the nurse use when working with a Jackson-Pratt drain?

• A. Strip the tubing to remove clots by milking the tubing back toward the client
• B. Empty the drain when the amount of fluid reaches 25 cc
• C. Strip the tubing to remove clots by milking the tubing away from the client
• D. Maintain the level of the drain above the client's incision

Correct answer: C

Rationale: A Jackson-Pratt drain is a type of active wound drain that may be placed following a surgical procedure. This drain actively draws excess blood and fluid out of the wound. If clots develop within the tubing, the nurse should strip the tubing by milking it in a direction away from the client. This action helps to ensure the drain remains patent and effective. Option A is incorrect because the tubing should be milked away from the client, not towards. Option B is incorrect as the drain should be emptied based on the healthcare provider's orders, not at a fixed volume. Option D is incorrect because the level of the drain should be below the level of the incision to allow drainage by gravity.

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