Nursing Elites

1. Which of the following is a cause of hypothyroidism?

• A. Overproduction of cortisol
• B. Autoimmune destruction of the thyroid gland
• C. Overactivity of the thyroid gland
• D. Insufficient iodine intake

Correct answer: B

Rationale: The correct answer is B: Autoimmune destruction of the thyroid gland. In hypothyroidism, the thyroid gland does not produce enough hormones to meet the body's needs. This can be due to autoimmune destruction of the thyroid gland, where the body's immune system mistakenly attacks the thyroid tissue. Choices A, C, and D are incorrect. Overproduction of cortisol is associated with conditions like Cushing's syndrome, overactivity of the thyroid gland is a characteristic of hyperthyroidism, and insufficient iodine intake can lead to goiter but not necessarily hypothyroidism.

2. A patient presents with a rash from poison ivy. The nurse knows that this is which type of hypersensitivity?

• A. Type I
• B. Type II
• C. Type III
• D. Type IV

Correct answer: D

Rationale: A rash from poison ivy is an example of a type IV hypersensitivity reaction. Type IV hypersensitivity reactions are delayed cell-mediated immune responses involving T cells. This type of reaction is characterized by a delayed onset, typically occurring 48-72 hours after exposure to the antigen. Choice A, Type I hypersensitivity reactions, are immediate hypersensitivity reactions mediated by IgE antibodies. Choices B and C, Type II and Type III hypersensitivity reactions, involve antibody-mediated cytotoxicity and immune complex deposition, respectively, which are not characteristic of poison ivy-induced rashes.

3. A 65-year-old man is admitted to the intensive care unit from the operating room after a triple coronary artery bypass graft. He is intubated and on a ventilator. Lactic acid levels were normal postoperatively, but now they are rising. The increased level could be an indication of:

• A. excessive sedation
• B. bowel ischemia
• C. excessive volume infusion in the operating room
• D. mild hypothermia postoperatively

Correct answer: B

Rationale: In this scenario, the rising lactic acid levels in a 65-year-old man after a coronary artery bypass graft could indicate bowel ischemia. Bowel ischemia can lead to anaerobic metabolism, causing an increase in lactic acid levels. Excessive sedation may cause respiratory depression but would not directly lead to rising lactic acid levels. Excessive volume infusion in the operating room might cause fluid overload but would not typically result in rising lactic acid levels. Mild hypothermia postoperatively could lead to shivering and increased oxygen consumption, but it is less likely to be the primary cause of rising lactic acid levels in this context.

4. When teaching a young woman about the use of hormonal contraceptives, a nurse should emphasize that these drugs are most effective when taken:

• A. Immediately after sexual intercourse.
• B. At the same time each day.
• C. Before going to bed at night.
• D. On an empty stomach.

Correct answer: B

Rationale: The correct answer is B: 'At the same time each day.' Hormonal contraceptives should be taken consistently at the same time each day to maintain stable hormone levels, which is crucial for their effectiveness. Taking them at random times can increase the risk of contraceptive failure. Choices A, C, and D are incorrect because taking hormonal contraceptives immediately after sexual intercourse, before going to bed at night, or on an empty stomach does not align with the recommended usage instructions for these drugs.

5. After a thoracentesis on a client with a pleural effusion, which nursing intervention is most important post-procedure?

• A. Monitor for signs of infection.
• B. Assess for signs of bleeding or hematoma.
• C. Monitor vital signs and respiratory status.
• D. Instruct the client to rest and limit physical activity.

Correct answer: B

Rationale: The correct answer is to assess for signs of bleeding or hematoma. After a thoracentesis, it is crucial to monitor for any bleeding or hematoma formation at the puncture site, as this can lead to complications. Monitoring for signs of infection (Choice A) is essential but is usually a delayed concern compared to the immediate risk of bleeding post-procedure. While monitoring vital signs and respiratory status (Choice C) is important, assessing for bleeding takes precedence to address any immediate complications. Instructing the client to rest and limit physical activity (Choice D) is relevant for general post-procedure care but is not the most critical intervention in this scenario.

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