Nursing Elites

1. Which of the following lipid abnormalities is a risk factor for the development of atherosclerosis and peripheral vascular disease?

• A. Low concentration of triglycerides.
• B. High levels of high-density lipoprotein (HDL) cholesterol.
• C. High levels of low-density lipoprotein (LDL) cholesterol.
• D. Low levels of LDL cholesterol.

Correct answer: C

Rationale: The correct answer is C: High levels of low-density lipoprotein (LDL) cholesterol. High levels of LDL cholesterol contribute to the development of atherosclerosis and peripheral vascular disease by being deposited in the blood vessel walls, leading to the formation of plaques that can obstruct blood flow. Choice A is incorrect as a low concentration of triglycerides is not typically associated with an increased risk of atherosclerosis or PVD. Choice B is incorrect as high levels of high-density lipoprotein (HDL) cholesterol are actually considered protective against atherosclerosis as it helps remove cholesterol from arteries. Choice D is incorrect as low levels of LDL cholesterol are not typically considered a risk factor for atherosclerosis or PVD.

2. Which of the following symptoms would a healthcare provider expect to find in a patient with hyperkalemia?

• A. Muscle cramps.
• B. Hypertension.
• C. Bradycardia.
• D. Tachycardia.

Correct answer: D

Rationale: Tachycardia is the correct symptom to expect in a patient with hyperkalemia. Hyperkalemia, or high potassium levels in the blood, can affect the electrical activity of the heart. Increased potassium levels can lead to changes in the heart's rhythm, potentially causing tachycardia (rapid heart rate) or other cardiac arrhythmias. Muscle cramps (choice A) are not typically associated with hyperkalemia. Hypertension (choice B) is not a common symptom of hyperkalemia; in fact, high potassium levels can sometimes cause low blood pressure. Bradycardia (choice C), or a slow heart rate, is usually not a primary symptom of hyperkalemia; instead, hyperkalemia tends to be associated with faster heart rates or arrhythmias.

3. A client who had a C-5 spinal cord injury 2 years ago is admitted to the emergency department with the diagnosis of autonomic dysreflexia secondary to a full bladder. Which assessment finding should the nurse expect this client to exhibit?

• A. Complaints of chest pain and shortness of breath
• B. Hypotension and venous pooling in the extremities
• C. Profuse diaphoresis and severe, pounding headache
• D. Pain and burning sensation upon urination and hematuria

Correct answer: C

Rationale: Autonomic dysreflexia is a life-threatening condition commonly seen in clients with spinal cord injuries above the T6 level. It is characterized by a sudden onset of excessively high blood pressure due to a noxious stimulus below the level of injury, often a distended bladder. The exaggerated sympathetic response leads to vasoconstriction, resulting in symptoms such as profuse diaphoresis (sweating) and a severe, pounding headache. These symptoms are the body's attempt to lower blood pressure. Complaints of chest pain and shortness of breath (Choice A) are not typical findings in autonomic dysreflexia. Hypotension and venous pooling (Choice B) are opposite manifestations of autonomic dysreflexia, which is characterized by hypertension. Pain and burning sensation upon urination and hematuria (Choice D) are indicative of a urinary tract infection and not specific to autonomic dysreflexia.

4. When conducting discharge teaching for a client diagnosed with diverticulitis, which diet instruction should the nurse include?

• A. Have small, frequent meals and sit up for at least two hours after meals
• B. Eat a bland diet and avoid spicy foods
• C. Eat a high-fiber diet and increase fluid intake
• D. Eat a soft diet with increased intake of milk and milk products

Correct answer: C

Rationale: For a client diagnosed with diverticulitis, the nurse should instruct them to eat a high-fiber diet and increase fluid intake. This diet helps in managing diverticulitis by promoting bowel regularity and preventing complications such as diverticular inflammation or infection. Choice A of having small, frequent meals and sitting up for at least two hours after meals may be beneficial for gastroesophageal reflux disease but is not specific to diverticulitis. Choice B of eating a bland diet and avoiding spicy foods is not the preferred recommendation for diverticulitis management. Choice D of eating a soft diet with increased intake of milk and milk products may not provide enough fiber to aid in diverticulitis management, and the increased intake of dairy products may worsen symptoms in some individuals.

5. To evaluate the positive effect of furosemide (Lasix) 40 mg/day in a client with chronic kidney disease (CKD), what is the best action for the nurse to take?

• A. Obtain daily weights of the client.
• B. Auscultate heart and breath sounds.
• C. Palpate the client’s abdomen.
• D. Assess the client’s diet history.

Correct answer: A

Rationale: The correct answer is A. Furosemide (Lasix) is a loop diuretic used to manage fluid overload and hypertension in clients with CKD. Monitoring daily weights is crucial as weight changes reflect fluid status. Each kilogram of weight change approximately corresponds to 1 liter of fluid retention or loss, making it essential for evaluating the medication's effectiveness. Auscultating heart and breath sounds is more relevant for heart failure cases with fluid retention, not specifically for assessing the effect of furosemide in CKD. Palpating the abdomen is not a direct indicator of furosemide's effectiveness; instead, assessing for edema would be appropriate. While assessing the client's diet history is important to monitor electrolyte balance due to potassium loss with furosemide, it does not directly evaluate the medication's efficacy.

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