Nursing Elites

1. In emphysema, what features result in impaired oxygenation?

• A. The bronchioles are inflamed and filled with mucus
• B. The alveoli have lost surfactant and collapse
• C. Enlarged, permanently inflated alveoli
• D. The accumulation of purulent fluid in the bronchioles

Correct answer: C

Rationale: The correct answer is C. In emphysema, impaired oxygenation results from enlarged and permanently inflated alveoli, leading to reduced surface area for gas exchange. Choices A, B, and D are incorrect. In emphysema, bronchioles are not typically filled with mucus, alveoli losing surfactant and collapsing is more characteristic of conditions like atelectasis, and purulent fluid accumulation in the bronchioles is commonly seen in conditions like pneumonia, not emphysema.

2. A patient is being treated with raloxifene (Evista) for osteoporosis. What should the nurse teach the patient about this medication?

• A. It is used as a selective estrogen receptor modulator to prevent bone loss.
• B. It works by decreasing bone formation and increasing bone resorption.
• C. It should be taken with food to reduce gastrointestinal side effects.
• D. It may cause weight gain and fluid retention.

Correct answer: C

Rationale: The correct answer is C. Raloxifene is a selective estrogen receptor modulator (SERM) used to prevent bone loss. It should be taken with food to reduce gastrointestinal side effects, not on an empty stomach. Choices A and B are incorrect because raloxifene is indeed a SERM that prevents bone loss, but it does not directly work by increasing bone formation or decreasing bone resorption. Choice D is incorrect as weight gain and fluid retention are not common side effects of raloxifene.

3. When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is:

• A. positively charged.
• B. inhibitory.
• C. overstimulated.
• D. dormant.

Correct answer: B

Rationale: Acetylcholine acts as an inhibitory neurotransmitter at the sinoatrial node. It slows down the heart rate by decreasing the firing rate of the sinoatrial node, which serves as the heart's natural pacemaker. Neurotransmitters do not have a charge, so choice A is incorrect. Choice C is wrong as overstimulation is not a characteristic of acetylcholine at the sinoatrial node. Choice D is also incorrect because acetylcholine actively influences heart rate regulation when released at the sinoatrial node.

4. The early stages of atheroma development are characterized by:

• A. macrophages full of oxidized low-density lipoprotein (LDL; i.e., foam cells) in the intima
• B. accumulation of lipids in the intima (i.e., fatty streak)
• C. accumulation of proteins such as collagen and elastin (i.e., fibrous cap)
• D. development of calcium and a necrotic lipid core

Correct answer: A

Rationale: The correct answer is A. In the early stages of atheroma development, macrophages accumulate oxidized low-density lipoprotein (LDL) and transform into foam cells, leading to the formation of fatty streaks in the intima of blood vessels. This process is a hallmark of the initial stages of atherosclerosis. Choice B is incorrect as it describes the accumulation of lipids in the intima, which is a later event following foam cell formation. Choice C is also incorrect as it refers to the accumulation of proteins forming the fibrous cap, which occurs at a later stage to stabilize the atheroma. Choice D is incorrect as it describes the development of calcium and a necrotic lipid core, typically seen in advanced atherosclerosis rather than the early stages.

5. In a 70-year-old man with a history of chronic obstructive pulmonary disease (COPD) reporting increasing shortness of breath, wheezing, and cough, which finding would indicate a potential exacerbation of his COPD?

• A. Increased wheezing
• B. Decreased respiratory rate
• C. Improved exercise tolerance
• D. Decreased sputum production

Correct answer: A

Rationale: The correct answer is A: Increased wheezing. In COPD exacerbations, there is a worsening of symptoms such as increased wheezing due to airway inflammation and narrowing. Choices B, C, and D are incorrect. Decreased respiratory rate would not be expected in COPD exacerbation as it is usually a compensatory mechanism to maintain oxygenation. Improved exercise tolerance is not a typical finding in exacerbations but rather a sign of improvement. Decreased sputum production is also not indicative of exacerbation, as exacerbations are often associated with increased sputum production.

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