Nursing Elites

1. The major difference between a grand mal and petit mal seizure is that a person with a grand mal seizure will have _______________ and the person with a petit mal seizure will not.

• A. convulsive movements
• B. sleep apnea
• C. atonic movements
• D. flaccidity

Correct answer: A

Rationale: The major difference between a grand mal and petit mal seizure is the presence or absence of convulsive movements. Grand mal seizures are characterized by convulsive movements, including jerking of limbs and loss of consciousness. In contrast, petit mal seizures, also known as absence seizures, typically involve brief episodes of staring or eye blinking without convulsive movements. Therefore, choice A, 'convulsive movements,' is the correct answer. Choices B, 'sleep apnea,' and D, 'flaccidity,' are incorrect as they are not associated with the characteristics of grand mal or petit mal seizures. Choice C, 'atonic movements,' is also incorrect as petit mal seizures do not involve atonic movements, but rather absence behaviors such as staring spells.

2. A patient's chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute?

• A. Decreased HR
• B. Paresthesias
• C. Muscle weakness of the extremities
• D. Migraines

Correct answer: D

Rationale: The correct answer is 'Migraines.' Migraines are not a symptom typically associated with hyperkalemia. In acute hyperkalemia, one would not expect to see migraines. Symptoms of hyperkalemia often include muscle weakness, paresthesias, and cardiac manifestations such as bradycardia or even cardiac arrest. Therefore, choices A, B, and C are more commonly associated with acute hyperkalemia compared to migraines, making it the correct choice.

3. The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take?

• A. Teach about the reason for the blood tests.
• B. Schedule an appointment for a chest x-ray.
• C. Teach about the need to get sputum specimens for 2 to 3 consecutive days.
• D. Instruct the patient to expectorate three specimens as soon as possible.

Correct answer: C

Rationale: The correct action for the nurse to take is to teach the patient about the need to collect sputum specimens for 2 to 3 consecutive days for bacteriologic testing for M. tuberculosis. It is important to obtain these specimens on different days rather than all at once. Blood tests are not used for tuberculosis testing, so teaching about blood tests is not relevant. While a chest x-ray is important in tuberculosis diagnosis, it is not a bacteriologic test. The appearance on a chest x-ray alone is not sufficient to diagnose TB as other diseases can have similar findings.

4. A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient's lab results would expect which of the following changes in laboratory findings?

• A. Elevated serum calcium
• B. Low serum parathyroid hormone (PTH)
• C. Elevated serum vitamin D
• D. Low urine calcium

Correct answer: A

Rationale: In primary hyperparathyroidism, there is excess secretion of parathyroid hormone (PTH) leading to increased resorption of calcium from bones and decreased excretion of calcium by the kidneys. This results in elevated serum calcium levels. Elevated serum calcium is a hallmark characteristic of primary hyperparathyroidism, making it the correct answer. Low serum parathyroid hormone (PTH) (Choice B) is incorrect because primary hyperparathyroidism is associated with elevated PTH levels due to the malfunction of the parathyroid glands. Elevated serum vitamin D (Choice C) is incorrect because primary hyperparathyroidism is not typically associated with elevated vitamin D levels. Low urine calcium (Choice D) is incorrect as primary hyperparathyroidism leads to decreased calcium excretion by the kidneys, resulting in high levels of calcium in the urine.

5. The healthcare provider is educating a parent about side effects of routine immunizations. Which of the following must be reported immediately?

• A. Irritability
• B. Slight edema at the injection site
• C. Local tenderness
• D. Temperature of 102.5?F

Correct answer: D

Rationale: A temperature of 102.5�F or higher following immunization is considered an adverse reaction and should be reported immediately. This could indicate a more serious systemic response to the vaccine. Irritability, slight edema at the injection site, and local tenderness are common, mild side effects of routine immunizations and do not typically require immediate reporting. Other reactions that should be reported immediately include excessive crying for more than 3 hours, seizure activity, and the presence of tender, swollen, or reddened areas at the injection site.

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