Nursing Elites

1. A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. On which aspect of the nervous system listed below would her health care providers focus their diagnostic efforts?

• A. The thalamus
• B. The pituitary
• C. The hypothalamus
• D. The midbrain

Correct answer: C

Rationale: The correct answer is C: The hypothalamus. The hypothalamus plays a central role in regulating endocrine and autonomic functions, including fluid and electrolyte balance. In this case, the girl's symptoms of deficits in endocrine and autonomic nervous system control, along with fluid and electrolyte imbalances, point towards dysfunction in the hypothalamus. Choices A, B, and D are incorrect because the thalamus is mainly involved in sensory relay, the pituitary gland regulates various hormones but is controlled by the hypothalamus, and the midbrain is responsible for motor control and arousal, not endocrine or autonomic functions.

2. After a patient is exposed to a specific antigen, B cells will differentiate into:

• A. B cytotoxic cells
• B. Plasma cells
• C. Bursal cells
• D. Clonal equivalents

Correct answer: B

Rationale: After exposure to a specific antigen, B cells undergo differentiation into plasma cells. Plasma cells are responsible for producing antibodies in response to the antigen. Choice A ('B cytotoxic cells') is incorrect because B cells do not differentiate into cytotoxic cells; cytotoxic cells are typically associated with T cells. Choice C ('Bursal cells') is incorrect as bursal cells are specific to birds and not relevant to human immune responses. Choice D ('Clonal equivalents') is incorrect as it does not describe the differentiation process of B cells exposed to antigens.

3. During a clinical assessment of a 68-year-old client who has suffered a head injury, a neurologist suspects that the client has sustained damage to her vagus nerve (CN X). Which assessment finding is most likely to lead the physician to this conclusion?

• A. The client has difficulty swallowing.
• B. The client has loss of gag reflex.
• C. The client has an inability to smell.
• D. The client has impaired eye movement.

Correct answer: B

Rationale: The correct answer is B. Damage to the vagus nerve can result in the loss of the gag reflex, which is a key indicator for the neurologist. Difficulty swallowing (Choice A) is more associated with issues related to the glossopharyngeal nerve (CN IX) and hypoglossal nerve (CN XII). An inability to smell (Choice C) is related to the olfactory nerve (CN I), and impaired eye movement (Choice D) is typically associated with damage to the oculomotor nerve (CN III), trochlear nerve (CN IV), or abducens nerve (CN VI), not the vagus nerve.

4. Cellular swelling is:

• A. Irreversible
• B. Evident early in all types of cellular injury
• C. Manifested by decreased intracellular sodium
• D. None of the above is correct

Correct answer: B

Rationale: Cellular swelling is indeed evident early in all types of cellular injury. This occurs due to the influx of water into the cell, leading to swelling. Choice A is incorrect because cellular swelling is reversible if the injury is not severe. Choice C is incorrect because cellular swelling is not manifested by decreased intracellular sodium; in fact, it is associated with increased intracellular sodium due to water influx. Choice D is incorrect as option B is the correct statement.

5. A patient is starting on alendronate (Fosamax) for osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?

• A. Take the medication with a full glass of water and remain upright for at least 30 minutes.
• B. Take the medication at bedtime to ensure absorption during sleep.
• C. Take the medication with milk to enhance calcium absorption.
• D. Take the medication with food to prevent gastrointestinal upset.

Correct answer: A

Rationale: The correct answer is to take alendronate with a full glass of water and remain upright for at least 30 minutes. This is essential to prevent esophageal irritation and ensure proper absorption. Choice B is incorrect because taking alendronate at bedtime can increase the risk of esophageal irritation due to lying down. Choice C is incorrect as taking alendronate with milk can reduce its absorption. Choice D is incorrect because alendronate should be taken on an empty stomach to enhance its effectiveness.

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