Nursing Elites

1. A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

• A. IgA
• B. IgD
• C. IgE
• D. IgG

Correct answer: D

Rationale: IgG is the only immunoglobulin that can cross the placental barrier, providing passive immunity to the fetus. About 70-80% of the immunoglobulins in the blood are IgG. Specific IgG antibodies are generated after an initial exposure to an antigen, offering long-term protection against microorganisms. IgG antibodies are critical for protecting the fetus as they can be rapidly reproduced upon re-exposure to the same antigen. IgA is primarily found in mucosal areas, IgD is involved in antigen recognition, and IgE is associated with allergic reactions, but they do not provide the same level of protection to the fetus as IgG.

2. You are responsible for reviewing the nursing unit's refrigerator. Which of the following drugs, if found inside the fridge, should be removed?

• A. Nadolol (Corgard)
• B. Opened (in-use) Humulin N injection
• C. Urokinase (Kinlytic)
• D. Epoetin alfa IV (Epogen)

Correct answer: A

Rationale: Nadolol (Corgard) should be removed if found inside the fridge because it is supposed to be stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Storing it in the refrigerator can alter its effectiveness and stability. Option B, the opened Humulin N injection, should not be stored in the refrigerator as it is an in-use product and can remain at room temperature for a certain period as per manufacturer guidelines. Option C, Urokinase (Kinlytic), and Option D, Epoetin alfa IV (Epogen), do not require refrigeration and can be stored at room temperature. Therefore, Nadolol (Corgard) is the drug that should be removed from the fridge.

3. An 85-year-old male has been losing mobility and gaining weight over the last two months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?

• A. CBC (complete blood count)
• B. ECG (electrocardiogram)
• C. Thyroid function tests
• D. CT scan

Correct answer: C

Rationale: The symptoms of weight gain and poor temperature tolerance in an elderly male suggest a potential thyroid dysfunction. Thyroid function tests are crucial in differentiating between hyperthyroidism, hypothyroidism, and a euthyroid state. These tests involve measuring the serum levels of thyroid hormones T3 and T4, also known as thyroxine, to evaluate thyroid function accurately. A complete blood count (Choice A) would not directly address the symptoms presented. An electrocardiogram (Choice B) assesses heart activity and would not be the primary test for these symptoms. A CT scan (Choice D) provides detailed images of internal organs and structures, which would not be the initial investigation for the described symptoms.

4. A client is undergoing radiation therapy for treatment of thyroid cancer. Following the radiation, the client develops xerostomia. Which of the following best describes this condition?

• A. Cracks in the corners of the mouth
• B. Peeling skin from the tongue and gums
• C. Increased dental caries
• D. Dry mouth

Correct answer: D

Rationale: Xerostomia, also known as dry mouth, is a common side effect of radiation therapy in the head and neck region. It occurs when the salivary glands are damaged during treatment, reducing saliva production and causing a dry sensation in the mouth. The correct answer is 'Dry mouth' (option D). Choice A, 'Cracks in the corners of the mouth,' describes angular cheilitis, a condition linked to nutritional deficiencies or candida infection. Choice B, 'Peeling skin from the tongue and gums,' is more indicative of conditions like oral thrush or mucositis. Choice C, 'Increased dental caries,' is a consequence of reduced saliva flow but does not specifically describe xerostomia.

5. A 16-month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her, and begins to cry. What would be the initial action by the nurse?

• A. Arrange to change client care assignments
• B. Explain that this behavior is expected
• C. Discuss the appropriate use of 'time-out'
• D. Explain that the child needs extra attention

Correct answer: B

Rationale: When encountering a 16-month-old child exhibiting fear of strangers by clinging to the parent and crying, it is essential for the nurse to explain that this behavior is expected. Fear of strangers typically emerges around 6-8 months of age and can continue into the toddler years and beyond. This behavior is a normal part of development as the child is displaying attachment and trust in familiar caregivers. Changing client care assignments, discussing 'time-out,' or suggesting the child needs extra attention are not appropriate initial actions in this situation. Changing care assignments is unnecessary and does not address the child's emotional needs. Discussing 'time-out' is not relevant as it pertains to discipline strategies for older children. Suggesting the child needs extra attention may misinterpret the situation; the child's behavior is a normal response to a new environment and does not necessarily indicate a need for additional attention.

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