Nursing Elites

1. 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.

2. A patient with systemic candidiasis has been prescribed flucytosine. The nurse should be aware of the need to administer this drug with which of the following?

• A. Vitamin D and calcium supplements
• B. Fluconazole (Diflucan)
• C. Amphotericin B
• D. Penicillin G

Correct answer: C

Rationale: The correct answer is C: Amphotericin B. When treating systemic candidiasis, Amphotericin B is the drug of choice, not flucytosine. Amphotericin B is an antifungal medication used to treat severe fungal infections like systemic candidiasis. Choices A, B, and D are incorrect because vitamin D and calcium supplements, fluconazole, and penicillin G are not the drugs of choice for treating systemic candidiasis.

3. How should the nurse respond to a 72-year-old patient diagnosed with benign prostatic hypertrophy (BPH) who is skeptical about tamsulosin (Flomax) for symptom relief?

• A. “Flomax can increase the amount of urine your kidneys produce, resulting in better urine flow.”
• B. “Flomax can relax your prostate and your bladder neck, making it easier to pass urine.”
• C. “Flomax makes your urine less alkaline, reducing the irritation that makes your prostate swell.”
• D. “Flomax increases the strength of your bladder muscle and results in a stronger flow of urine.”

Correct answer: B

Rationale: The correct response is choice B because it explains the mechanism of action of Flomax, which helps the patient understand how the medication works. By stating that Flomax relaxes the prostate and bladder neck, making it easier to pass urine, the nurse is addressing the patient's concerns about symptom relief. Choices A, C, and D provide inaccurate information about Flomax's mechanism of action and do not directly address the patient's skepticism or concerns.

4. A home care nurse visits a patient who is bed-bound and lives in a 12-story high-rise apartment complex. Her daughter states that she has small red skin lesions over her body and she has been itching. What parasite is most likely responsible for this patient's skin lesions?

• A. Sarcoptes scabiei
• B. Pediculus humanus corporis
• C. Pediculus humanus pubis
• D. Toxoplasma gondii

Correct answer: A

Rationale: The correct answer is Sarcoptes scabiei. Sarcoptes scabiei is a parasitic mite that causes scabies, characterized by small red skin lesions and intense itching. Pediculosis corporis (choice B) refers to body lice, which do not cause the specific symptoms described. Pediculosis pubis (choice C) is caused by pubic lice and presents differently from the symptoms described. Toxoplasma gondii (choice D) is a parasite that causes toxoplasmosis, but it does not typically manifest with small red skin lesions and itching.

5. During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which component of her nervous system contains the highest level of control of her arm and hand action?

• A. Cerebral cortex
• B. Basal ganglia
• C. Brainstem
• D. Cerebellum

Correct answer: A

Rationale: The correct answer is A: Cerebral cortex. The cerebral cortex, particularly the motor cortex, is responsible for the voluntary control of precise movements such as turning a page. The cerebral cortex plays a crucial role in the highest level of control of motor functions, including those of the arm and hand. Choice B, Basal ganglia, is more involved in motor planning and coordination, while choice C, Brainstem, is responsible for basic life functions and reflexes. Choice D, Cerebellum, is primarily involved in coordination, precision, and accurate timing of movements, rather than the highest level of control for specific actions like page-turning.

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