Nursing Elites

1. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which component of his 'white matter' has most likely been damaged?

• A. The inner layer (archilayer)
• B. The middle layer (paleolayer)
• C. The outer layer (neolayer)
• D. The reticular formation

Correct answer: C

Rationale: The correct answer is C: The outer layer (neolayer). The white matter of the spinal cord consists of three layers: the outer layer (neolayer), the middle layer (paleolayer), and the inner layer (archilayer). Damage to the outer layer (neolayer) is likely to affect fine motor skills, explaining the loss of fine motor function in the finger and thumb while gross motor movements remain intact. Choices A, B, and D are incorrect as they do not correspond to the specific layer of the white matter that is typically associated with fine motor control.

2. What is the best method to identify which type of stroke the client has?

• A. Obtain a 12-lead electrocardiogram STAT
• B. Obtain a blood specimen for electrolytes and blood cultures
• C. Ask the client about current allergies
• D. Obtain a cranial computerized tomogram (CT) STAT

Correct answer: D

Rationale: The correct answer is to obtain a cranial computerized tomogram (CT) STAT. A cranial CT scan is the best method to quickly identify the type of stroke a client is experiencing. Options A, B, and C are not appropriate for identifying the type of stroke as they are not specific to assessing stroke types.

3. Which of the following nursing diagnoses would provide the most plausible indication for the use of epoetin alfa (Epogen) in a patient with renal failure?

• A. Risk for infection related to decreased erythropoiesis
• B. Activity intolerance related to decreased oxygen-carrying capacity
• C. Powerlessness related to sequelae of renal failure
• D. Ineffective breathing pattern related to inadequate erythropoietin synthesis

Correct answer: B

Rationale: The correct answer is B. In a patient with renal failure, the use of epoetin alfa (Epogen) is primarily aimed at addressing the decreased oxygen-carrying capacity due to impaired erythropoiesis. Epoetin alfa is a medication that stimulates red blood cell production, thereby improving the oxygen-carrying capacity of the blood. This would directly address the activity intolerance commonly seen in patients with renal failure. Choices A, C, and D are incorrect because they do not directly relate to the primary purpose of using epoetin alfa in this context. Risk for infection, powerlessness, and ineffective breathing pattern are important considerations in the care of a patient with renal failure, but they are not the primary indications for using epoetin alfa.

4. A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes as:

• A. Pale in color
• B. Present in various sizes
• C. Able to assume various shapes
• D. Live only a few days

Correct answer: B

Rationale: The correct answer is B: 'Present in various sizes.' Anisocytosis refers to erythrocytes that are present in various sizes, indicating an abnormality in the uniformity of red blood cell size. Choice A is incorrect because anisocytosis does not refer to the color of erythrocytes. Choice C is incorrect as anisocytosis does not involve the shape of erythrocytes. Choice D is incorrect as anisocytosis does not determine the lifespan of erythrocytes.

5. A patient is being treated with finasteride (Proscar) for benign prostatic hyperplasia (BPH). What expected outcome should the nurse include in the patient teaching?

• A. The medication will cure BPH after treatment is complete.
• B. The effects of the medication may take several weeks or months to become noticeable.
• C. The medication may cause increased hair growth.
• D. The medication may decrease libido.

Correct answer: B

Rationale: The correct answer is B. Finasteride is used to reduce the size of the prostate gland in patients with BPH, leading to decreased urinary frequency and urgency over several weeks or months. Choice A is incorrect because finasteride does not cure BPH but helps manage symptoms. Choice C is incorrect as increased hair growth is associated with another medication called minoxidil, not finasteride. Choice D is incorrect since finasteride may cause a decrease in libido as a side effect.

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