Nursing Elites

1. A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as 'like an electric shock.' The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain?

• A. Temporal arteritis
• B. Trigeminal neuralgia
• C. Migraine headache
• D. Cluster headache

Correct answer: B

Rationale: The correct answer is B: Trigeminal neuralgia. Trigeminal neuralgia is characterized by severe, stabbing pain in the distribution of the trigeminal nerve, often triggered by light touch, chewing, or brushing teeth. In this case, the patient's symptoms of sharp, intermittent facial pain triggered by activities like chewing and touching her face are classic for trigeminal neuralgia. Choices A, C, and D are incorrect. Temporal arteritis typically presents with unilateral headache, jaw claudication, and visual symptoms. Migraine headaches are usually throbbing in nature and often associated with nausea, vomiting, and sensitivity to light and sound. Cluster headaches are characterized by severe unilateral pain around the eye with autonomic symptoms like lacrimation and nasal congestion.

2. A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

• A. Sideroblastic anemia
• B. Hemolytic anemia
• C. Pernicious anemia
• D. Iron deficiency anemia

Correct answer: B

Rationale: The correct answer is B, Hemolytic anemia. Normocytic-normochromic anemia is a type of anemia characterized by normal-sized and normal-colored red blood cells. Hemolytic anemia is a condition where red blood cells are destroyed prematurely, leading to normocytic-normochromic anemia. Sideroblastic anemia (Choice A) is characterized by ringed sideroblasts in the bone marrow. Pernicious anemia (Choice C) is due to vitamin B12 deficiency. Iron deficiency anemia (Choice D) is characterized by microcytic-hypochromic red blood cells.

3. After a thoracentesis on a client with a pleural effusion, which nursing intervention is most important post-procedure?

• A. Monitor for signs of infection.
• B. Assess for signs of bleeding or hematoma.
• C. Monitor vital signs and respiratory status.
• D. Instruct the client to rest and limit physical activity.

Correct answer: B

Rationale: The correct answer is to assess for signs of bleeding or hematoma. After a thoracentesis, it is crucial to monitor for any bleeding or hematoma formation at the puncture site, as this can lead to complications. Monitoring for signs of infection (Choice A) is essential but is usually a delayed concern compared to the immediate risk of bleeding post-procedure. While monitoring vital signs and respiratory status (Choice C) is important, assessing for bleeding takes precedence to address any immediate complications. Instructing the client to rest and limit physical activity (Choice D) is relevant for general post-procedure care but is not the most critical intervention in this scenario.

4. An immunology nurse is caring for a patient. While planning care, which principle will the nurse remember? The primary role of IgA1 is to prevent infections in the:

• A. Blood
• B. Kidneys
• C. Lungs
• D. Mucous membranes

Correct answer: A

Rationale: The correct answer is A: Blood. IgA1 is mainly found in the blood and plays a crucial role in preventing infections by neutralizing pathogens. While IgA1 can be present in other body areas, its primary function is associated with preventing infections in the blood. Choices B, C, and D are incorrect as IgA1 is not primarily associated with the kidneys, lungs, or mucous membranes.

5. 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.

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