Nursing Elites

1. Which of the following correctly identifies the plasma protein inflammatory mediator systems?

• A. Phagocytic, interferon, and complement systems.
• B. Complement, fibrinolytic, and clotting systems.
• C. Complement, clotting, and kinin systems.
• D. Complement, clotting, and acute phase reactant systems.

Correct answer: C

Rationale: The correct answer is C: Complement, clotting, and kinin systems. These are the three main plasma protein inflammatory mediator systems. The complement system helps in inflammation and immune responses, the clotting system is involved in blood coagulation, and the kinin system regulates inflammation and blood pressure. Choice A is incorrect because interferon is not part of the plasma protein inflammatory mediator systems. Choice B is incorrect because the fibrinolytic system is not a primary inflammatory mediator system. Choice D is incorrect because acute phase reactants are not part of the plasma protein inflammatory mediator systems.

2. Which individual is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult:

• A. client who developed rhabdomyolysis and ischemic injury after a tourniquet application.
• B. who suffered a bone-depth laceration to the shoulder during a knife attack.
• C. who had his forearm partially crushed by gears during an industrial accident.
• D. client who had nerves transected during surgery to remove a tumor from the mandible.

Correct answer: C

Rationale: The correct answer is C. Crushing-type injuries to the peripheral nervous system generally have a better prognosis compared to nerve transections or lacerations. In the scenario provided, the individual who had his forearm partially crushed by gears during an industrial accident is likely to have a better chance of recovery compared to nerve transection (choice D) or laceration (choice B). Rhabdomyolysis and ischemic injury after tourniquet application (choice A) are not directly related to peripheral nerve injury and do not indicate a better prognosis for recovery.

3. Which pathophysiologic process causes the decreased glomerular filtration rate in a patient with acute glomerulonephritis?

• A. Decreased renal-induced constriction of the renal arteries
• B. Immune complex deposition, increased capillary permeability, and cellular proliferation
• C. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial hydrostatic pressure
• D. Scar tissue formation throughout the proximal convoluted tubule secondary to toxin-induced collagen synthesis

Correct answer: B

Rationale: The correct answer is B: Immune complex deposition, increased capillary permeability, and cellular proliferation. In acute glomerulonephritis, immune complexes deposit in the glomerulus, leading to inflammation, increased capillary permeability, and cellular proliferation. These processes collectively reduce the glomerular filtration rate. Choices A, C, and D do not accurately describe the pathophysiologic process in acute glomerulonephritis. Decreased renal-induced constriction of the renal arteries, necrosis of nephrons due to increased kidney interstitial hydrostatic pressure, and scar tissue formation in the proximal convoluted tubule are not the primary mechanisms responsible for the decreased filtration rate in this condition.

4. A client with multiple sclerosis (MS) is frustrated by tremors associated with the disease. How should the nurse explain why these tremors occur? Due to the demyelination of neurons that occurs in MS:

• A. there is an imbalance in acetylcholine and dopamine, leading to tremors.
• B. there is a disruption in nerve impulse conduction, causing tremors.
• C. muscles are unable to receive impulses, resulting in tremors.
• D. the reflex arc is disrupted, leading to muscle tremors.

Correct answer: B

Rationale: In multiple sclerosis (MS), demyelination of neurons disrupts nerve impulse conduction. This disruption in nerve impulses can lead to tremors, explaining why the client experiences tremors in MS. Choice A is incorrect because tremors in MS are primarily due to nerve conduction issues, not an imbalance in acetylcholine and dopamine. Choice C is incorrect as it oversimplifies the process; the issue lies in nerve impulses, not the muscle's ability to receive them. Choice D is incorrect as the primary cause of tremors in MS is the disruption in nerve impulse conduction, not the reflex arc being disrupted.

5. During an acute asthma exacerbation, what is the priority nursing intervention for a client with asthma?

• A. Administer corticosteroids to reduce airway inflammation.
• B. Position the client in high-Fowler's position.
• C. Administer short-acting beta-agonists (SABAs) as prescribed.
• D. Obtain a peak flow reading to assess the severity of the exacerbation.

Correct answer: C

Rationale: The priority nursing intervention during an acute asthma exacerbation is to administer short-acting beta-agonists (SABAs) as prescribed. SABAs help in quickly relieving bronchospasm and are considered the first-line treatment for acute exacerbations. Administering corticosteroids, positioning the client, and obtaining a peak flow reading are important interventions but come after administering SABAs in the management of acute asthma exacerbation.

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