Nursing Elites

1. Which immunoglobulin is the first to appear in response to a new antigen?

• A. IgA
• B. IgG
• C. IgE
• D. IgM

Correct answer: D

Rationale: The correct answer is IgM. IgM is the first immunoglobulin to appear in response to a new antigen. It is produced initially during the primary immune response. IgA is mainly found in mucosal areas and secretions. IgG is produced in a secondary immune response and is the most abundant immunoglobulin in the bloodstream. IgE is involved in allergic reactions and parasitic infections, not the initial response to a new antigen.

2. A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely contributing to her complaint?

• A. Somatic pain resulting from pressure on the parietal peritoneum
• B. Referred pain from her small bowel
• C. Visceral pain resulting from distension and ischemia
• D. Neuropathic pain resulting from autonomic dysfunction

Correct answer: C

Rationale: Visceral pain is associated with distension, ischemia, and inflammation of internal organs. In the case of a small bowel obstruction, the intense, diffuse pain reported by the client is likely due to the distension and ischemia of the small bowel. Somatic pain (Choice A) would be more localized and sharp, typically arising from the parietal peritoneum. Referred pain (Choice B) is pain perceived at a site distant from the actual pathology. Neuropathic pain (Choice D) involves dysfunction or damage to the nervous system and is not typically associated with the described physiologic phenomenon of distension and ischemia in the context of a small bowel obstruction.

3. 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.

4. What instruction should the nurse include in this patient's health education regarding chloroquine phosphate (Aralen) for malaria prophylaxis?

• A. “Take your pill on the same day each week.”
• B. “Watch out for any unusual rash on your trunk and arms, but this isn't cause for concern.”
• C. “Remember to take your chloroquine on an empty stomach.”
• D. “We'll provide you with enough syringes and teach you how to inject the drug.”

Correct answer: A

Rationale: The correct instruction for the nurse to include in this patient's health education regarding chloroquine phosphate (Aralen) for malaria prophylaxis is to “Take your pill on the same day each week.” This is essential because chloroquine is typically taken once a week on the same day to ensure consistent protection against malaria. Choice B is incorrect because while rashes are a possible side effect of chloroquine, they are not a usual occurrence and should be reported to the healthcare provider. Choice C is incorrect because chloroquine does not need to be taken on an empty stomach. Choice D is incorrect as chloroquine is typically administered orally, not by injection.

5. A 25-year-old just had a colonoscopy and was diagnosed with Crohn disease. Which of the following symptoms is consistent with this diagnosis?

• A. Right lower quadrant cramping
• B. Severe bloody diarrhea
• C. Nausea and vomiting
• D. Mostly affects the rectum

Correct answer: A

Rationale: The correct answer is A: Right lower quadrant cramping. Crohn's disease commonly presents with abdominal pain, particularly in the right lower quadrant. Choice B, severe bloody diarrhea, is more characteristic of ulcerative colitis, another type of inflammatory bowel disease. Choice C, nausea and vomiting, are not typical symptoms of Crohn's disease. Choice D is incorrect as Crohn's disease can affect any part of the gastrointestinal tract, not just the rectum.

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