Nursing Elites

1. Which of the following is a characteristic symptom of multiple sclerosis (MS)?

• A. Muscle atrophy.
• B. Severe pain.
• C. Vision problems.
• D. Hearing loss.

Correct answer: C

Rationale: Vision problems are a characteristic symptom of multiple sclerosis (MS) due to demyelination of the optic nerve. This can lead to issues such as optic neuritis, blurred vision, double vision, or even total vision loss. Muscle atrophy (Choice A) is not a primary symptom of MS but can occur as a secondary effect of decreased mobility. Severe pain (Choice B) is not a typical symptom of MS, though some individuals may experience pain related to muscle spasms or other factors. Hearing loss (Choice D) is not commonly associated with MS unless there is an unrelated concurrent condition affecting the auditory system.

2. A healthcare professional is reading the chest x-ray report of a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. The healthcare professional interprets that the tube is positioned above:

• A. The first tracheal cartilaginous ring
• B. The point where the larynx connects to the trachea
• C. The bifurcation of the right and left main stem bronchi
• D. The area connecting the oropharynx to the laryngopharynx

Correct answer: C

Rationale: The carina is a cartilaginous ridge that separates the openings of the two main stem (right and left) bronchi. If an endotracheal tube is inserted past the carina, the tube will enter the right main stem bronchus due to the natural curvature of the airway. This positioning is dangerous as only the right lung will be ventilated. It can be identified as only the right lung will have breath sounds and rise and fall with ventilation. Choices A, B, and D are incorrect as they do not relate to the specific anatomical landmark mentioned in the scenario.

3. When assessing an individual with peripheral vascular disease, which clinical manifestation would indicate complete arterial obstruction in the lower left leg?

• A. Aching pain in the left calf.
• B. Burning pain in the left calf.
• C. Numbness and tingling in the left leg.
• D. Coldness of the left foot and ankle.

Correct answer: D

Rationale: Coldness of the left foot and ankle is the correct clinical manifestation indicating complete arterial obstruction in the lower left leg. Complete arterial obstruction results in reduced blood flow, leading to decreased temperature in the affected area. Aching pain (Choice A) and burning pain (Choice B) are more commonly associated with partial obstructions or ischemia, while numbness and tingling (Choice C) can be indicative of nerve involvement or compromised circulation, but not specifically complete arterial obstruction. The coldness in the foot and ankle is a result of severely reduced blood flow, which impairs the delivery of oxygen and nutrients to the tissues in that area, leading to a lower temperature. This symptom is a critical indicator of a more severe blockage compared to the other options provided.

4. The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?

• A. Contact the provider to request an order for serum electrolytes.
• B. Encourage the patient to consume less fluids.
• C. Report symptoms of hyperkalemia to the provider.
• D. Request an order to increase the patient’s potassium dose.

Correct answer: A

Rationale: Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes to assess the patient's potassium levels. Encouraging the patient to consume less fluids would not address the underlying issue of potential hyperkalemia. Reporting symptoms of hyperkalemia to the provider is not as proactive as directly requesting serum electrolytes. Increasing the patient's potassium dose would worsen hyperkalemia, which is already suspected based on the symptoms presented.

5. A client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 62, PaCO2 59, and HCO3. Which statement describes the most likely cause of the simultaneous increase in both the PaO2 and the PaCO2?

• A. The hypercapnia resulted from the rapid respirations.
• B. The hypoxic drive was reduced by the oxygen therapy.
• C. The client had a pneumothorax which restricted ventilation.
• D. The client had a pulmonary embolism that reduced perfusion.

Correct answer: B

Rationale: In patients with COPD, oxygen therapy can reduce the hypoxic drive, which is the primary stimulus for breathing in these individuals. By providing supplemental oxygen, the hypoxic drive is diminished, resulting in decreased respiratory effort. As a consequence, the PaO2 may increase due to the supplemental oxygen, but this can lead to a decrease in the respiratory drive and subsequent retention of carbon dioxide, causing an increase in PaCO2 levels. Option A is incorrect because rapid respirations would typically lower PaCO2 levels. Option C is incorrect as a pneumothorax would lead to impaired gas exchange and decreased PaO2 levels without necessarily affecting PaCO2 levels. Option D is incorrect as a pulmonary embolism would typically result in ventilation-perfusion mismatch and decreased PaO2 levels without directly impacting PaCO2 levels.

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