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MSN 570 Advanced Pathophysiology Final 2024
1. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand?
- A. Eosinophils
- B. Neutrophils
- C. Leukotrienes
- D. Monocytes
Correct answer: B
Rationale: Neutrophils are the first responders to a bacterial infection. They are phagocytes that engulf and destroy bacteria, playing a crucial role in the early stages of the immune response. Eosinophils are primarily involved in combating parasitic infections and allergic reactions, not bacterial infections. Leukotrienes are signaling molecules that contribute to inflammation and immune responses, but they are not cells. Monocytes are another type of white blood cell that differentiates into macrophages and dendritic cells, playing a role in immune response but not as immediate as neutrophils.
2. A client with amyotrophic lateral sclerosis (ALS) is admitted to the hospital. Which intervention should the nurse include in the plan of care?
- A. Administer muscle relaxants as prescribed.
- B. Assist the client with activities of daily living (ADLs).
- C. Provide nutritional support to prevent aspiration.
- D. Encourage the client to participate in physical therapy.
Correct answer: C
Rationale: The correct intervention for a client with ALS is to provide nutritional support to prevent aspiration. ALS causes muscle weakness, including the muscles used for swallowing, increasing the risk of aspiration. Providing proper nutrition and support can help prevent this complication. Administering muscle relaxants (Choice A) may not be suitable for ALS as it can further weaken muscles. While assisting with ADLs (Choice B) and encouraging physical therapy (Choice D) are important aspects of care, the priority for a client with ALS is to prevent complications related to swallowing and nutrition.
3. A nurse is caring for a patient who is being treated with clomiphene citrate (Clomid) for infertility. What side effect should the nurse warn the patient about?
- A. Headaches and visual disturbances
- B. Nausea and vomiting
- C. Hot flashes and abdominal discomfort
- D. Fatigue and depression
Correct answer: C
Rationale: The correct answer is C: 'Hot flashes and abdominal discomfort.' Clomiphene citrate, commonly known as Clomid, can lead to hot flashes and abdominal discomfort as side effects. It is important for the nurse to warn the patient about these potential effects. Choices A, B, and D are incorrect because headaches and visual disturbances, nausea and vomiting, as well as fatigue and depression are not commonly associated with clomiphene citrate use.
4. A client arrives with symptoms of stroke. What should the nurse assess first?
- A. Level of consciousness
- B. Blood pressure
- C. Pupil reaction
- D. Heart rate
Correct answer: A
Rationale: Assessing the level of consciousness is a critical first step in evaluating a potential stroke. Changes in the level of consciousness can indicate the severity and location of brain damage, helping to guide immediate interventions. Assessing blood pressure, pupil reaction, and heart rate are also important aspects of the assessment in a suspected stroke patient. However, the priority is to quickly determine the client's level of consciousness to assess their neurological status.
5. Which of the following is not included in the care plan of a client with moderate cognitive impairment involving dementia of the Alzheimer’s type?
- A. Daily structured schedule
- B. Positive reinforcement for performing activities of daily living
- C. Stimulating environment
- D. Use of validation techniques
Correct answer: C
Rationale: In the care plan for a client with moderate cognitive impairment involving Alzheimer's type dementia, a stimulating environment is not included as it can potentially increase confusion. Therefore, it is important to provide a familiar, structured, and predictable environment to reduce stress and disorientation. Daily structured schedules help in maintaining routine and familiarity, positive reinforcement encourages engagement in activities, and validation techniques help in communicating effectively with the client by acknowledging their feelings and reality orientation.
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