Nursing Elites

1. What causes hepatic encephalopathy?

• A. A brain infection
• B. Increased ammonia levels in the bloodstream
• C. Decreased albumin blood levels
• D. Untreated chronic bronchitis

Correct answer: B

Rationale: Hepatic encephalopathy is caused by increased ammonia levels in the bloodstream. Ammonia, a byproduct of protein metabolism normally processed by the liver, accumulates in the bloodstream when the liver is unable to function properly. This excess ammonia affects brain function, leading to symptoms of hepatic encephalopathy. Choices A, C, and D are incorrect because they do not directly relate to the pathophysiology of hepatic encephalopathy.

2. In which disorder does a Staphylococcus aureus organism produce a toxin leading to exfoliation and large blister formation?

• A. Herpes simplex I virus
• B. Herpes simplex II virus
• C. Necrotizing fasciitis
• D. Cellulitis

Correct answer: B

Rationale: The correct answer is 'Herpes simplex I virus.' This disorder is known as Staphylococcal scalded skin syndrome (SSSS), where a Staphylococcus aureus organism produces an exfoliative toxin leading to skin exfoliation and large blister formation. Choices B, C, and D are incorrect. Herpes simplex viruses (I and II) cause different types of skin lesions and do not lead to exfoliation and blister formation. Necrotizing fasciitis is a severe soft tissue infection, while cellulitis is a bacterial skin infection that does not typically involve exfoliation and blister formation like in SSSS.

3. A report comes back indicating that muscular atrophy has occurred. A nurse recalls that muscular atrophy involves a decrease in muscle cell size:

• A. Number
• B. Size
• C. Vacuoles
• D. Lipofuscin

Correct answer: B

Rationale: The correct answer is B: Size. Muscular atrophy is characterized by a reduction in the size of muscle cells. This decrease in size can be due to various factors such as disuse, aging, or disease. Choice A, Number, is incorrect because muscular atrophy does not involve a decrease in the number of muscle cells but rather their size. Choice C, Vacuoles, is incorrect as vacuoles are not directly related to the definition of muscular atrophy. Choice D, Lipofuscin, is incorrect as lipofuscin is a pigment associated with aging and has no direct connection to the decrease in muscle cell size seen in muscular atrophy.

4. A patient is being treated with hormone replacement therapy (HRT) for menopausal symptoms. What are the risks associated with long-term HRT that the nurse should discuss with the patient?

• A. HRT may increase the risk of cardiovascular events and breast cancer.
• B. HRT may decrease the risk of osteoporosis.
• C. HRT may increase the risk of venous thromboembolism.
• D. HRT may improve mood and energy levels.

Correct answer: A

Rationale: The correct answer is A. Long-term HRT is associated with increased risks of cardiovascular events and breast cancer. These risks should be discussed with the patient to ensure they are informed about the potential adverse effects. Choice B is incorrect because HRT does not decrease the risk of osteoporosis; in fact, it may increase the risk of certain conditions like cardiovascular events. Choice C is incorrect as HRT is associated with an increased risk of venous thromboembolism, not a decreased risk. Choice D is incorrect because while HRT may have positive effects like improving symptoms of menopause, it is not primarily indicated for improving mood and energy levels.

5. While assessing a critically ill client in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the client became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is:

• A. metabolic acidosis that occurs spontaneously following any dysrhythmias.
• B. interruption of the blood/oxygen supply to the brain.
• C. massive cerebrovascular accident (CVA) resulting from increased perfusion.
• D. a blood clot coming from the heart and occluding the carotid arteries.

Correct answer: B

Rationale: The correct answer is B. Ventricular tachycardia (VT) can disrupt the normal heart function, leading to a decreased cardiac output. This decreased output can interrupt the blood supply to the brain, causing the client to become unresponsive. Metabolic acidosis (Choice A) is not the most likely cause of unresponsiveness in this scenario. A massive cerebrovascular accident (CVA) (Choice C) would not result from increased perfusion. A blood clot occluding the carotid arteries (Choice D) may lead to a stroke but is not the most likely cause of sudden unresponsiveness in this situation.

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