Nursing Elites

1. A toddler is displaying signs/symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The client's family asks how he got this. The nurse will respond:

• A. This could result from playing in soil and then ingesting bacteria that is now attacking his motor neurons.
• B. No one really knows how this disease is formed. We just know that in time, he may grow out of it.
• C. This is a degenerative disorder that tends to be inherited as an autosomal recessive trait.
• D. This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well.

Correct answer: C

Rationale: The correct answer is C. Spinal muscular atrophy (SMA) is an inherited disorder, often autosomal recessive, that affects lower motor neurons. Choice A is incorrect because SMA is not caused by ingesting bacteria from playing in soil. Choice B is incorrect as SMA is not something that a person grows out of. Choice D is incorrect because SMA is not a demyelination disorder that affects nerve roots and muscle groups.

2. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Has your child received all recommended vaccinations?
• B. Has your child been feeding poorly or showing signs of constipation?
• C. Has your child been exposed to any sick individuals?
• D. Has your child been displaying signs of respiratory distress?

Correct answer: B

Rationale: The correct answer is B. Poor feeding and constipation are common early symptoms of infant botulism, which is caused by a neurotoxin that impairs muscle function. Option A is unrelated to the presentation of botulism. Option C does not directly relate to the symptoms of botulism. Option D is more indicative of respiratory issues rather than the constellation of symptoms seen in botulism.

3. A patient is prescribed acyclovir (Zovirax) for the treatment of genital herpes. What is the expected outcome of this medication?

• A. Decreased testosterone production
• B. Decreased libido
• C. Decreased viral shedding
• D. Decreased bacterial replication

Correct answer: C

Rationale: The expected outcome of acyclovir (Zovirax) for the treatment of genital herpes is decreased viral shedding. Acyclovir is an antiviral medication that works by inhibiting the replication of the herpes virus, thereby reducing viral shedding and helping to control outbreaks. Choice A, decreased testosterone production, and Choice B, decreased libido, are unrelated outcomes of acyclovir treatment for genital herpes. Choice D, decreased bacterial replication, is also incorrect as acyclovir specifically targets viruses and does not affect bacterial replication.

4. In a 70-year-old man with a history of chronic obstructive pulmonary disease (COPD) reporting increasing shortness of breath, wheezing, and cough, which finding would indicate a potential exacerbation of his COPD?

• A. Increased wheezing
• B. Decreased respiratory rate
• C. Improved exercise tolerance
• D. Decreased sputum production

Correct answer: A

Rationale: The correct answer is A: Increased wheezing. In COPD exacerbations, there is a worsening of symptoms such as increased wheezing due to airway inflammation and narrowing. Choices B, C, and D are incorrect. Decreased respiratory rate would not be expected in COPD exacerbation as it is usually a compensatory mechanism to maintain oxygenation. Improved exercise tolerance is not a typical finding in exacerbations but rather a sign of improvement. Decreased sputum production is also not indicative of exacerbation, as exacerbations are often associated with increased sputum production.

5. What is the characteristic of the condition of leukemia?

• A. A benign growth of skin cells
• B. A malignant growth of skin cells
• C. A malignant growth of white blood cells
• D. A benign growth of white blood cells

Correct answer: C

Rationale: The correct answer is C: 'A malignant growth of white blood cells.' Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells. These cells are malignant and impair the normal function of healthy blood cells. Choices A, B, and D are incorrect because leukemia does not involve skin cells or benign growths; instead, it specifically refers to the abnormal proliferation of white blood cells.

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