Nursing Elites

1. When assessing a client with amyotrophic lateral sclerosis (ALS), the nurse should expect which of the following findings?

• A. mental confusion
• B. muscular weakness
• C. sensory loss
• D. emotional liability

Correct answer: B

Rationale: Clients with ALS typically present with progressive muscular weakness and wasting as a hallmark feature of the disease. This weakness affects voluntary muscles, leading to challenges in mobility and daily activities. Sensory loss is not a characteristic feature of ALS, and individuals usually maintain their mental clarity without experiencing mental confusion. Emotional liability, characterized by sudden, uncontrolled changes in emotions, is not a common finding in ALS. While individuals may experience periods of grief due to the progressive nature of the disease, emotional liability is not a usual manifestation. Therefore, the correct finding to expect when assessing a client with ALS is muscular weakness.

2. Which direction given to the nursing assistant is most likely to accomplish the task of getting a urine specimen delivered to the lab immediately after collection?

• A. "Make it a stat delivery."?
• B. "Please do it as soon as you can after break."?
• C. "This client is delirious, and we're worried about urinary sepsis."?
• D. "Take this client to the bathroom now and collect a urine specimen from this voiding. Take the specimen to the lab immediately."?

Correct answer: D

Rationale: Effective delegation depends on clear, concise direction that leaves no room for question or interpretation on the part of the one being delegated to. In this scenario, the most appropriate direction is to ensure the urine specimen is collected promptly and delivered to the lab immediately. Choice A is too vague and does not specify the urgency required. Choice B does not emphasize the immediate need for the specimen to be delivered. Choice C introduces unnecessary medical information that is beyond the scope of a nursing assistant and may cause confusion. Therefore, choice D is the correct answer as it provides clear instructions for immediate action without room for misunderstanding.

3. A 45-year-old client with type I diabetes is in need of support services upon discharge from a skilled rehabilitation unit. Which of the following services is an example of a skilled support service?

• A. shopping for groceries
• B. house cleaning
• C. transportation to physician's visits
• D. medication instruction

Correct answer: D

Rationale: The correct answer is 'medication instruction.' This service involves educating the client on how to properly take their medications, which requires a certain level of expertise and skill. Grocery shopping, house cleaning, and transportation to physician's visits are considered unskilled services as they do not involve specialized knowledge or training. In contrast, medication instruction is a skilled service that necessitates specific training to ensure the client's safety and adherence to their medication regimen.

4. When a client has a chest drainage system in place, where should the system be placed?

• A. above the level of the client's chest
• B. at the level of the client's shoulders
• C. at the level of the chest
• D. below the level of the chest

Correct answer: D

Rationale: A chest drainage system should be placed below the level of the client's chest to ensure proper drainage of fluid from the chest. Placing the system above the level of the chest or at the shoulders would not allow gravity to assist in the drainage process, potentially leading to complications such as fluid accumulation. Similarly, placing it at the level of the chest would not create the necessary gravity-dependent flow for effective drainage, which is crucial for the proper functioning of the chest drainage system.

5. Which of the following syndromes associated with incomplete lesions of the spinal cord results from damage to one-half of the spinal cord?

• A. Brown-S�quard syndrome
• B. posterior cord syndrome
• C. central cord syndrome
• D. cauda equina syndrome

Correct answer: A

Rationale: Brown-S�quard syndrome is indeed associated with incomplete lesions of the spinal cord, and it specifically results from damage to one-half of the spinal cord. This syndrome manifests as ipsilateral motor paralysis, ipsilateral loss of vibration and proprioception, and contralateral loss of pain and temperature sensation. Posterior cord syndrome mainly involves the loss of proprioception and vibratory sense, while sparing motor function and pain sensation. Central cord syndrome typically presents with more weakness in the upper extremities compared to the lower extremities due to central spinal cord damage. Cauda equina syndrome affects the nerve roots at the level of the conus medullaris, leading to symptoms like lower extremity weakness, numbness, and bowel/bladder dysfunction.

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