Nursing Elites

1. Which disorder is characterized by demyelination of neurons in the central nervous system?

• A. Multiple sclerosis
• B. Parkinson's disease
• C. Alzheimer's disease
• D. Huntington's disease

Correct answer: A

Rationale: Multiple sclerosis is the correct answer. It is an autoimmune disease that specifically targets and damages the myelin sheath surrounding neurons in the central nervous system. This demyelination disrupts the transmission of nerve signals and leads to a variety of neurological symptoms. Parkinson's disease (Choice B), Alzheimer's disease (Choice C), and Huntington's disease (Choice D) are neurodegenerative disorders that do not primarily involve demyelination of neurons in the CNS. Parkinson's disease is characterized by the loss of dopamine-producing neurons, Alzheimer's disease by the formation of plaques and tangles in the brain, and Huntington's disease by a genetic mutation affecting nerve cells.

2. The nurse is providing care for a client with type 1 diabetes mellitus who is receiving NPH insulin. The nurse notices that the client's evening glucose levels are consistently above 260 mg/dl. What does this indicate?

• A. States that her feet are constantly cold and feel numb
• B. A wound on the ankle that starts to drain and becomes painful
• C. Consecutive evening serum glucose greater than 260 mg/dl
• D. Reports nausea in the morning but still able to eat breakfast

Correct answer: C

Rationale: High evening glucose levels suggest that the current insulin dosage may be inadequate to control the client's blood sugar levels effectively. This indicates poor glycemic control and the need for a possible adjustment in the insulin regimen. Option A describes symptoms of peripheral neuropathy, which are not directly related to the elevated glucose levels but may be a long-term complication of diabetes. Option B describes a wound infection, which is not directly related to the client's high glucose levels. Option D mentions morning nausea, which could be due to various causes and is not directly related to the high evening glucose levels.

3. A client who is at full-term gestation is in active labor and complains of a cramp in her leg. Which intervention should the PN implement?

• A. Massage the calf and foot
• B. Elevate the leg above the heart
• C. Check the pedal pulse in the affected leg
• D. Extend the leg and flex the foot

Correct answer: D

Rationale: During labor, muscle cramps are common due to prolonged muscle tension. The correct intervention to alleviate a cramp in the leg is to extend the leg and flex the foot. This action helps relieve the muscle spasm by stretching and contracting the muscles. Massaging the calf and foot (Choice A) may not be as effective in relieving the cramp as extending and flexing the leg. Elevating the leg above the heart (Choice B) is not necessary and may not directly address the cramp. Checking the pedal pulse (Choice C) is important for assessing circulation, but it does not directly address the muscle cramp.

4. The PN notes that a UAP is ambulating a male client who had a stroke and has right-sided weakness. The UAP is walking on the client's left side. Which action should the PN take?

• A. Instruct the UAP to walk on the client's affected side
• B. Take over the ambulation and provide guidance to the UAP immediately
• C. Provide the client with an assistive device, such as a cane or walker
• D. Tell the UAP to take the client back to his room

Correct answer: A

Rationale: The correct action for the PN to take is to instruct the UAP to walk on the client’s affected side. This is essential to provide the necessary support and prevent falls, especially when the client has weakness on one side due to a stroke. Walking on the affected side helps provide stability and assistance to the weaker side. Choice B is incorrect because it would be more appropriate for the PN to provide immediate guidance and correct the UAP's positioning rather than taking over the task completely. Choice C is incorrect because while assistive devices may be beneficial, the immediate concern is the UAP's positioning during ambulation, not providing the client with an assistive device. Choice D is incorrect as there is no indication to return the client to his room unless it is necessary for his safety or well-being.

5. The nurse observes a UAP performing oral hygiene on an unconscious client who is lying in a flat side-lying position with an emesis basin on a towel under the chin. Which action should the nurse take?

• A. Stop the procedure and tell the UAP to place the client in a Fowler's position
• B. Praise the UAP for doing the oral hygiene but encourage family participation
• C. Tell the UAP to continue because the unconscious client is positioned safely
• D. Enroll the UAP in a hospital education class on conducting safe client care

Correct answer: C

Rationale: The correct answer is to tell the UAP to continue because the unconscious client is positioned safely for oral care. Placing an unconscious client in a side-lying position helps prevent aspiration, and having an emesis basin under the chin is appropriate to catch any fluids. Therefore, the nurse should acknowledge that the UAP is performing the procedure correctly. Choices A, B, and D are incorrect. Placing the client in a Fowler's position is not necessary for this procedure as the client is already positioned safely. Praise and encouragement for family participation are important aspects but not the immediate action needed in this scenario. Enrolling the UAP in a hospital education class is not warranted as the current procedure is being performed correctly.

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