Nursing Elites

1. A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?

• A. Merkel cell
• B. Schwann cell
• C. Reed-Sternberg cell
• D. Kupffer cell

Correct answer: C

Rationale: Reed-Sternberg cells are characteristic of Hodgkin lymphoma. These large abnormal cells have a bi-lobed or multi-lobed nucleus and are essential for diagnosing Hodgkin lymphoma through histological examination. Merkel cells are associated with Merkel cell carcinoma, Schwann cells are related to nerve sheaths, and Kupffer cells are liver macrophages. Therefore, choices A, B, and D are incorrect for Hodgkin lymphoma.

2. A client with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days after the amputation, the client confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can:

• A. administer a psychotropic medication to help the client cope with the sensation of his amputated leg.
• B. explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site.
• C. call the physician and request an order for a psychological consult.
• D. educate the client that this area has an unusually abnormal increase in sensitivity to sensation but that it will go away with time.

Correct answer: B

Rationale: The correct answer is B. The sensation of feeling the amputated limb is known as phantom limb pain, which is common after amputation. One theory suggests that it occurs because the end of a regenerating nerve becomes trapped in the scar tissue at the amputation site. Administering psychotropic medication (choice A) is not the first-line treatment for phantom limb pain. Requesting a psychological consult (choice C) is premature without first addressing the known pathophysiological basis of phantom limb pain. Educating the client that the sensitivity will go away with time (choice D) is not entirely accurate as phantom limb pain can persist long-term.

3. A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?

• A. Memory loss as a natural consequence of aging
• B. Difficulty coping with physical and psychological changes
• C. Severe cognitive impairment that occurs rapidly
• D. Loss of cognitive abilities, impairing the ability to perform activities of daily living

Correct answer: D

Rationale: The correct answer is D. Dementia is characterized by a loss of cognitive abilities that impairs the individual's capacity to perform activities of daily living. Choice A is incorrect because dementia is not simply memory loss related to aging but involves broader cognitive deficits. Choice B is incorrect as it does not capture the comprehensive cognitive decline seen in dementia. Choice C is incorrect as dementia typically progresses gradually rather than rapidly, and it is not solely about severe cognitive impairment but also impacts daily functioning.

4. A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. On which aspect of the nervous system listed below would her health care providers focus their diagnostic efforts?

• A. The thalamus
• B. The pituitary
• C. The hypothalamus
• D. The midbrain

Correct answer: C

Rationale: The correct answer is C: The hypothalamus. The hypothalamus plays a central role in regulating endocrine and autonomic functions, including fluid and electrolyte balance. In this case, the girl's symptoms of deficits in endocrine and autonomic nervous system control, along with fluid and electrolyte imbalances, point towards dysfunction in the hypothalamus. Choices A, B, and D are incorrect because the thalamus is mainly involved in sensory relay, the pituitary gland regulates various hormones but is controlled by the hypothalamus, and the midbrain is responsible for motor control and arousal, not endocrine or autonomic functions.

5. A patient is starting on a new oral contraceptive. What should the nurse emphasize about the timing of the medication?

• A. Take the medication at the same time each day to maintain stable hormone levels.
• B. Oral contraceptives should be taken in the morning to avoid nighttime side effects.
• C. Oral contraceptives can be taken at any time of day as long as the schedule is consistent.
• D. Oral contraceptives are effective immediately upon starting, regardless of timing.

Correct answer: A

Rationale: The correct answer is A. It is crucial for patients taking oral contraceptives to take the medication at the same time each day to maintain stable hormone levels and ensure their effectiveness in preventing pregnancy. Choice B is incorrect because there is no specific requirement to take oral contraceptives in the morning. Choice C is incorrect because consistency in timing is essential, but it should be at the same time each day. Choice D is incorrect because oral contraceptives may take some time to reach peak effectiveness, so it is important to emphasize the need for consistent timing.

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