Nursing Elites

1. A 44-year-old man presents with muscle weakness and fatigue. He states that he has experienced difficulty climbing stairs and even holding his arms up to comb his hair. Which test is most likely to help confirm the diagnosis?

• A. Electromyography (EMG)
• B. Nerve conduction studies
• C. Muscle biopsy
• D. Blood test for autoantibodies

Correct answer: A

Rationale: The correct answer is Electromyography (EMG). EMG is commonly used to diagnose conditions involving muscle weakness and fatigue, such as myasthenia gravis. Nerve conduction studies primarily assess nerve function rather than muscle involvement. While a muscle biopsy can provide valuable information, EMG is more specific for evaluating muscle function in this context. A blood test for autoantibodies may be helpful in certain autoimmune conditions but is not the primary test for confirming the diagnosis based on the patient's symptoms of muscle weakness and fatigue.

2. A client with amyotrophic lateral sclerosis (ALS) is admitted to the hospital. Which intervention should the nurse include in the plan of care?

• A. Administer muscle relaxants as prescribed.
• B. Assist the client with activities of daily living (ADLs).
• C. Provide nutritional support to prevent aspiration.
• D. Encourage the client to participate in physical therapy.

Correct answer: C

Rationale: The correct intervention for a client with ALS is to provide nutritional support to prevent aspiration. ALS causes muscle weakness, including the muscles used for swallowing, increasing the risk of aspiration. Providing proper nutrition and support can help prevent this complication. Administering muscle relaxants (Choice A) may not be suitable for ALS as it can further weaken muscles. While assisting with ADLs (Choice B) and encouraging physical therapy (Choice D) are important aspects of care, the priority for a client with ALS is to prevent complications related to swallowing and nutrition.

3. Prior to leaving on a backpacking trip to Southeast Asia, a college student has received a tetanus booster shot. This immunization confers protection by way of what immune process?

• A. Passive natural immunity
• B. Active natural immunity
• C. Passive artificial immunity
• D. Active artificial immunity

Correct answer: D

Rationale: The correct answer is D: Active artificial immunity. A tetanus booster shot confers protection through active artificial immunity. Active immunity involves the body producing its antibodies in response to an antigen, providing long-lasting protection. In this case, the tetanus booster shot triggers the student's immune system to produce specific antibodies against tetanus toxins. Choices A, B, and C are incorrect because passive immunity does not involve the individual's immune system producing antibodies; instead, it involves the direct transfer of antibodies from another source (natural or artificial) for immediate, but temporary, protection.

4. A patient taking an oral contraceptive missed one pill. What should the nurse teach the patient to do?

• A. Take two pills as soon as you remember, then continue the regular schedule.
• B. Take one pill as soon as you remember, then continue the regular schedule.
• C. Skip the missed pill and continue the regular schedule.
• D. Take two pills immediately, then continue the regular schedule.

Correct answer: A

Rationale: When a patient taking an oral contraceptive misses one pill, the correct action is to take two pills as soon as they remember and then continue the regular schedule. Option A is the correct answer because doubling up the dose helps maintain the effectiveness of the contraceptive. Option B is incorrect because taking only one pill after missing one may decrease contraceptive effectiveness. Option C is wrong as skipping the missed pill can also reduce effectiveness. Option D is inaccurate because taking two pills immediately is not necessary; the patient should take the missed pill as soon as remembered and then resume the regular dosing schedule.

5. What long-term risks should the nurse discuss with a patient starting on hormone replacement therapy (HRT)?

• A. HRT is associated with increased risks of cardiovascular events and breast cancer, so these risks should be discussed with the patient.
• B. HRT can improve mood and energy levels, but it also increases the risk of osteoporosis.
• C. HRT can increase the risk of venous thromboembolism, so patients should undergo regular screening.
• D. HRT decreases the risk of fractures, but it also increases the risk of developing diabetes.

Correct answer: A

Rationale: The correct answer is A. When starting on hormone replacement therapy (HRT), the nurse should discuss the increased risks of cardiovascular events and breast cancer with the patient. These risks are important to consider to make an informed decision. Choice B is incorrect as HRT does not increase the risk of osteoporosis; in fact, it may help prevent it. Choice C is incorrect as while HRT can increase the risk of venous thromboembolism, regular screening is not the primary focus for discussion. Choice D is incorrect as HRT does not decrease the risk of fractures and is not primarily associated with an increased risk of developing diabetes.

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