RN exams medical-surgical practice questions set 32

Correct answer:

The papillary layer of the dermis is the uppermost layer of the dermis, characterized by loose connective tissue and finger-like projections (papillae) that interlock with the deepest layer of the epidermis, the stratum basale. The stratum basale, also called the basal layer, is where new skin cells are produced and it rests directly on the papillary dermis, forming a strong connection via the basement membrane. The stratum spinosum lies above the basale and is thicker, with spiny cells, but it's not in direct contact with the papillary layer. The stratum granulosum is higher up, involved in keratinization, and the stratum corneum is the outermost dead layer, far from the dermis. The anatomical proximity and functional relationship between the papillary layer and stratum basale, including nutrient exchange and anchoring, make it the most closely associated layer.

Correct answer:

The patient's presentation of central obesity, moon face, buffalo hump, purple striae, and elevated cortisol levels strongly suggest Cushing's syndrome. Cushing's syndrome is a disorder characterized by excessive levels of cortisol, either due to an endogenous (e.g., adrenal tumor) or exogenous (e.g., prolonged steroid use) source. The classic physical features of Cushing's syndrome include central obesity with thin extremities (truncal obesity), moon face (rounding and reddening of the face), buffalo hump (accumulation of fat between the shoulders), and purple striae (stretch marks that are wide and purple in color). In the context of the elevated cortisol levels, these clinical signs are highly indicative of Cushing's syndrome. Hyperthyroidism, hypothyroidism, and diabetes mellitus would not typically present with the specific combination of symptoms described.

Correct answer:

The correct answer is B: Oxygen saturation rates of 91% to 95% are effective. This range is supported by the article by Newman (2014) as the optimal oxygen saturation levels for premature neonates. Here's the rationale: 1. The range of 91% to 95% falls within the typical target range for oxygen saturation in premature neonates, ensuring adequate oxygenation without the risk of hyperoxia or hypoxia. 2. Maintaining oxygen saturation within this range has been shown to improve outcomes and reduce the risk of complications in premature neonates. 3. The article by Newman likely provides evidence-based research supporting this specific range as the most effective for neonatal care. In summary, choices A, C, and D are incorrect because they do not align with the evidence-based optimal oxygen saturation range for premature neonates as supported by the referenced article.

Correct answer:

All of the above,' as age, amount of underlying tissue, and illness all influence skin integrity resistance. Age (A) affects skin thickness and elasticity elderly skin thins, losing resilience, while youthful skin is more robust. Amount of underlying tissue (B), like subcutaneous fat, cushions and protects skin; less tissue increases vulnerability to breakdown, as in malnourishment. Illness (C) weakens skin through impaired immunity or circulation, as in diabetes or infection, reducing repair capacity. Each factor independently impacts durability, and together, they compound risk, making 'All of the above' correct. In nursing, this holistic view guides risk assessment e.g., an elderly, thin patient with chronic illness is prone to ulcers. No single factor suffices; their synergy is critical, distinguishing D as the comprehensive choice per wound care principles.

Correct answer:

The correct answer is A: Apply splints. Splints help maintain proper positioning of joints to prevent contractures in burn patients. Splints provide support and protect the joints during the healing process. They help to prevent shortening and tightening of muscles and tissues, reducing the risk of contractures. B: Physical therapy two hours a day is not the most effective approach for preventing contractures in burn patients. While physical therapy is important for rehabilitation, excessive duration may not necessarily prevent contractures. C: Passive range of motion exercises are beneficial for maintaining joint flexibility, but they may not provide enough support to prevent contractures in burn patients. D: Occupational therapy one hour every other day focuses on activities of daily living and may not directly address the prevention of contractures.

Correct answer:

The correct order of steps for 2nd generation sequencing is C: DNA isolation, DNA fragmentation, primer ligation, amplification, sequencing. Firstly, DNA isolation is crucial to extract the DNA from the sample. Next, DNA fragmentation breaks the DNA into smaller fragments for sequencing. Primer ligation involves attaching primers to the DNA fragments. Amplification is necessary to make multiple copies of the DNA fragments for sequencing. Finally, sequencing is the process of determining the nucleotide sequence of the DNA fragments. This order ensures that the DNA is properly prepared and amplified before sequencing, leading to accurate results. Choices A, B, and D are incorrect because they do not follow the correct sequence of steps required for 2nd generation sequencing. Incorrect sequences may lead to errors in the sequencing process and inaccurate results.

Correct answer:

The correct order for the stages in skin regeneration following an injury is: 1) Blood clot/scab formation, 2) Epidermis covers granulation tissue, 3) Epidermis covers scar tissue, and 4) Calcium injection. Rationale: 1) Blood clot/scab formation occurs first to stop bleeding and prevent infection. 2) Epidermis covering granulation tissue signifies the growth of new tissue. 3) Epidermis covering scar tissue indicates the completion of tissue repair. 4) Calcium injection is not a typical stage in skin regeneration; it does not play a direct role in the natural healing process. Summary: Choice A is incorrect as it starts with covering scar tissue, which is a later stage. Choice B is incorrect as it introduces calcium injection, which is not a standard stage. Choice D is incorrect as it places calcium injection before blood clot formation, which is inaccurate.

Correct answer:

The correct answer is A: Elevated creatinine levels. Creatinine is a waste product that is normally filtered by the kidneys. Elevated creatinine levels indicate impaired kidney function, which is commonly seen in renal failure. Choice B, low potassium levels, is not typically associated with renal failure. In fact, renal failure is more likely to cause high potassium levels due to the kidneys' inability to excrete potassium effectively. Choice C, low calcium levels, are not directly indicative of renal failure. Renal failure can lead to disturbances in calcium levels, but low calcium levels alone are not a specific marker for renal failure. Choice D, high sodium levels, are also not typically associated with renal failure. In renal failure, there may be disturbances in sodium levels, but high sodium levels alone are not a direct indicator of renal failure.

Correct answer:

Proton pump inhibitors (PPIs) are commonly prescribed for conditions involving excessive stomach acid production, such as peptic ulcer disease. One of the potential adverse effects of PPIs, such as omeprazole or pantoprazole, is the risk of hypokalemia. Hypokalemia is a condition characterized by low levels of potassium in the bloodstream. Prolonged use of PPIs can inhibit the absorption of potassium in the intestines, leading to a decrease in potassium levels in the body. Hypokalemia can present with symptoms such as muscle weakness, fatigue, irregular heartbeat, and in severe cases, it can result in life-threatening complications like cardiac arrhythmias. Therefore, it is essential for the nurse to closely monitor the patient for signs and symptoms of hypokalemia while on PPI therapy, especially if the patient is at risk for developing electrolyte imbalances.

Correct answer:

The correct answer is A: Fluctuation of the fluid level within the water seal chamber. This indicates proper chest tube function as it shows that the system is maintaining the desired pressure and allowing for adequate drainage without obstruction. When the patient breathes in and out, the fluid level fluctuates due to changes in intrathoracic pressure. Explanation of other choices: B: Absence of fluid in the drainage tubing - This would indicate a problem with drainage, possibly due to a blockage in the tubing. C: Continuous bubbling within the water seal chamber - This would suggest an air leak in the system, which is not ideal as it can lead to lung collapse. D: Equal amounts of fluid drainage in each collection chamber - While equal drainage is good, it does not specifically indicate proper chest tube function like the fluctuation of the fluid level does.