Nursing Elites

1. 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.

2. In Guillain-Barre syndrome, what pathophysiologic process underlies the deficits that accompany the degeneration of myelin in the peripheral nervous system (PNS)?

• A. The destruction of myelin results in a reduction in Schwann cell production in the client's PNS.
• B. The lack of myelin surrounding nerve cells compromises the axonal transport system.
• C. Without remyelination, the axon will eventually die.
• D. A deficit of myelin makes the client more susceptible to infection by potential pathogens.

Correct answer: C

Rationale: In Guillain-Barre syndrome, the destruction of myelin leads to axonal damage. If remyelination does not occur, the axon will eventually degenerate and die, impacting nerve function. Choice A is incorrect because the destruction of myelin does not affect Schwann cell production. Choice B is incorrect as the lack of myelin directly affects the conduction of nerve impulses, not the axonal transport system. Choice D is incorrect as a deficit of myelin does not predispose the client to infections by potential pathogens.

3. A woman suffers from amenorrhea. Which of the following medications will most likely be prescribed?

• A. Testosterone
• B. Follicle-stimulating hormone
• C. Estrogen
• D. Lactate

Correct answer: C

Rationale: Estrogen is the correct answer. Amenorrhea, the absence of menstruation, is often due to hormonal imbalances. Estrogen plays a crucial role in regulating the menstrual cycle. Prescribing estrogen can help address these hormonal imbalances and restore menstrual cycles. Testosterone (Choice A) is not typically prescribed for amenorrhea in women as it can further disrupt hormonal balance. Follicle-stimulating hormone (Choice B) is involved in stimulating ovulation and follicle development, not the primary treatment for amenorrhea. Lactate (Choice D) is not a medication used to treat amenorrhea.

4. When preparing to administer parenteral acyclovir (Zovirax) to an 80-year-old patient with chronic renal failure and herpes simplex, what would the nurse expect in regard to the dose?

• A. The dose is smaller due to the herpes simplex infection.
• B. The dose is smaller based on the patient's kidney function.
• C. The dose is higher in treating genital herpes.
• D. The dose is higher if the creatinine clearance is above 4.0 mg/dL.

Correct answer: B

Rationale: In patients with chronic renal failure, especially in older adults, dosages of medications excreted renally need to be adjusted based on kidney function. Acyclovir is primarily eliminated by the kidneys, so in a patient with chronic renal failure, the dose would need to be smaller to prevent drug accumulation and toxicity. Choice A is incorrect because the dose adjustment is more related to the patient's kidney function than the presence of herpes simplex. Choice C is incorrect because the type of herpes infection does not determine the dose adjustment for acyclovir. Choice D is incorrect as the creatinine clearance is a more accurate measure of kidney function compared to creatinine levels.

5. What are the characteristics of the inflammatory process?

• A. Loss of function, coolness
• B. Pain, redness
• C. Heat, pallor
• D. Swelling, pallor

Correct answer: B

Rationale: The correct answer is B: Pain, redness. Inflammation is characterized by pain and redness as part of the body's response to tissue injury. Choice A, loss of function and coolness, are not primary characteristics of inflammation. Choice C, heat and pallor, may be present in some cases but are not as consistently associated with inflammation as pain and redness. Choice D, swelling and pallor, includes swelling which is common in inflammation but pallor is not a typical characteristic.

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