Nursing Elites

1. The charge nurse on a cardiac unit tells you a patient is exhibiting signs of right-sided heart failure. Which of the following would not indicate right-sided heart failure?

• A. Muscle tetany
• B. Syncope
• C. Numbness
• D. Anxiety

Correct answer: D

Rationale: The correct answer is 'Anxiety.' Anxiety is not a typical sign of right-sided heart failure. Right-sided heart failure usually presents with symptoms such as muscle tetany, syncope, and numbness. Muscle tetany can occur due to electrolyte imbalances seen in heart failure. Syncope can result from decreased cardiac output, leading to decreased perfusion to the brain. Numbness can occur due to poor circulation. While anxiety can be present in patients with various medical conditions, it is more commonly associated with respiratory acidosis or other psychological factors rather than right-sided heart failure.

2. A 46-year-old has returned from a heart catheterization and wants to get up to start walking 3 hours after the procedure. The nurse should:

• A. Tell the patient to remain with the leg straight for at least another hour and check the chart for activity orders.
• B. Allow the patient to begin limited ambulation with assistance.
• C. Recommend a physical therapy consultation for ambulation.
• D. Tell the patient to remain with the leg straight for another 6 hours and check the chart for activity orders.

Correct answer: A

Rationale: The correct answer is to tell the patient to remain with the leg straight for at least another hour after a heart catheterization before starting ambulation. This period allows for proper healing and reduces the risk of complications such as bleeding or hematoma formation at the catheter insertion site. Starting ambulation too soon can disrupt the healing process and lead to adverse events. Choice B is incorrect because limited ambulation should not be initiated shortly after the procedure as it may increase the risk of complications. Choice C is incorrect as physical therapy consultation is not typically necessary for initial ambulation post-heart catheterization; this can be managed by nursing staff. Choice D is incorrect as keeping the leg straight for 6 hours is excessive and unnecessary, potentially leading to complications such as deep vein thrombosis due to prolonged immobility.

3. During a stress test, a patient complains of severe chest pain. Which of the following medications is the most appropriate to relieve this discomfort?

• A. Aspirin
• B. Diazoxide
• C. Procardia
• D. Mannitol

Correct answer: C

Rationale: In this scenario, the most appropriate medication to relieve severe ischemic chest pain during a stress test is Procardia. Procardia, a calcium channel blocker, is effective in quickly alleviating chest pain by dilating coronary arteries, improving blood flow to the heart muscle. Aspirin, although important for antiplatelet effects, is not the best choice for immediate relief of severe chest pain. Diazoxide is a vasodilator used in hypertensive emergencies, not for acute chest pain. Mannitol is an osmotic diuretic used to reduce intracranial pressure, not for chest pain relief.

4. A nurse is teaching a client newly diagnosed with Emphysema about the disease process. Which of the following statements best explains the problems associated with emphysema and could be adapted for use in the nurse's discussion with the client?

• A. Hyperactivity of the medium-sized bronchi caused by an inflammatory response leads to wheezing and tightness in the chest.
• B. Larger than normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways.
• C. Vasodilation, congestion, and mucosal edema cause a chronic cough and sputum production.
• D. Chloride is not being transported properly, producing excess absorption of water and sodium, and thick viscous mucus

Correct answer: B

Rationale: The correct answer is: 'Larger than normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways.' Emphysema is a breakdown of the elastin and fiber network of the alveoli where the alveoli enlarge or the walls are destroyed. This alveolar destruction leads to the formation of larger-than-normal air spaces. Emphysema is one of a group of pulmonary diseases of a chronic nature characterized by increased resistance to airflow; the entity is part of chronic obstructive pulmonary disease (COPD). Choice A is incorrect because emphysema is not primarily characterized by hyperactivity of the medium-sized bronchi causing wheezing and tightness in the chest. Choice C is incorrect because vasodilation, congestion, and mucosal edema are not the primary mechanisms involved in emphysema, and they do not directly lead to chronic cough and sputum production. Choice D is incorrect because emphysema is not related to chloride transport issues and thick viscous mucus production.

5. A patient has recently been prescribed Zidovudine (Retrovir). The patient has AIDS. Which of the following side effects should the patient specifically watch out for?

• A. Weakness and SOB
• B. Fever and anemia
• C. Hypertension and SOB
• D. Fever and hypertension

Correct answer: B

Rationale: The correct answer is 'Fever and anemia.' Zidovudine (Retrovir) is known to cause anemia as a side effect due to its impact on the bone marrow. Fever is also a common side effect associated with Zidovudine use. Therefore, the patient should watch out for these specific side effects. Choice A (Weakness and SOB) is incorrect as shortness of breath (SOB) is not a commonly reported side effect of Zidovudine. Choice C (Hypertension and SOB) and Choice D (Fever and hypertension) are unrelated to the known side effects of Zidovudine, making them incorrect.

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