Nursing Elites

1. What is the etiology and most likely treatment for myasthenia gravis in a 22-year-old female college student?

• A. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids.
• B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins.
• C. Cerebellar lesions; surgical and immunosuppressive treatment.
• D. Excess acetylcholinesterase production; treatment with thymectomy.

Correct answer: B

Rationale: Myasthenia gravis is characterized by a decline in functioning acetylcholine receptors rather than autoimmune destruction of skeletal muscle cells (Choice A), cerebellar lesions (Choice C), or excess acetylcholinesterase production (Choice D). The most likely treatment for myasthenia gravis involves corticosteroids to reduce inflammation and intravenous immunoglobulins to block the antibodies attacking acetylcholine receptors. Intensive physical therapy and anabolic steroids are not primary treatments for myasthenia gravis.

2. Which of the following is not an autoimmune disease?

• A. Multiple sclerosis
• B. Pernicious anemia
• C. Goodpasture syndrome
• D. Transfusion reaction

Correct answer: D

Rationale: The correct answer is D, Transfusion reaction. Transfusion reaction is not an autoimmune disease because it occurs when the immune system responds to foreign blood cells, not to the body's own cells. Choices A, B, and C (Multiple sclerosis, Pernicious anemia, Goodpasture syndrome) are autoimmune diseases where the immune system mistakenly attacks the body's own tissues or organs.

3. When assessing a patient experiencing breakthrough bleeding while taking oral contraceptives, what should the nurse consider?

• A. The possibility of pregnancy
• B. The patient's adherence to the medication schedule
• C. The need for an increased dosage
• D. The effectiveness of the current oral contraceptive

Correct answer: B

Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, it is crucial for the nurse to consider the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of missed doses or inconsistent use, which can decrease the effectiveness of the oral contraceptive. Considering the possibility of pregnancy (Choice A) is important but secondary to assessing adherence. The need for an increased dosage (Choice C) is not typically the first consideration for breakthrough bleeding. Evaluating the effectiveness of the current oral contraceptive (Choice D) is relevant but should come after assessing adherence to the medication schedule.

4. Right-sided heart failure is characterized by:

• A. Immunosuppression
• B. Pulmonary edema
• C. Peripheral edema
• D. Coughing

Correct answer: C

Rationale: Right-sided heart failure is characterized by peripheral edema, which results from the buildup of fluid in the body. This fluid accumulates in the extremities due to the heart's inability to effectively pump blood forward. Choices A, B, and D are incorrect. Immunosuppression is not a typical feature of right-sided heart failure. Pulmonary edema is more commonly associated with left-sided heart failure, where fluid accumulates in the lungs. Coughing is a symptom that can be present in various conditions but is not a defining characteristic of right-sided heart failure.

5. The healthcare provider is caring for a client with an altered level of consciousness and needs to assess the withdrawal reflex. Which action should the healthcare provider perform?

• A. Apply a painful stimulus to see if the client pulls away.
• B. Check for pupil response to light.
• C. Assess the client's response to verbal commands.
• D. Observe the client's reaction to a cold stimulus.

Correct answer: A

Rationale: The withdrawal reflex is assessed by applying a painful stimulus and observing if the client pulls away. This response indicates a functioning reflex arc. Choices B, C, and D are incorrect as they do not involve testing the withdrawal reflex specifically. Checking for pupil response to light assesses the pupillary reflex, assessing the client's response to verbal commands evaluates their cognitive function, and observing the client's reaction to a cold stimulus tests for a different type of sensory response.

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