Nursing Elites

1. When assessing a 7-year-old child's pain after an emergency appendectomy, what is the most appropriate tool for the nurse to use?

• A. Use a visual analog scale (VAS) to assess the pain.
• B. Ask the child to rate their pain on a scale of 0 to 10.
• C. Use the Wong-Baker FACES scale to assess the pain.
• D. Ask the parents to describe the child's pain behavior.

Correct answer: C

Rationale: The correct answer is to use the Wong-Baker FACES scale to assess the child's pain. This scale is specifically designed for children and uses facial expressions of varying intensities to help them communicate their pain levels effectively. Choices A and B may not be as suitable for a young child who may have difficulty understanding or using a numerical scale. Choice D involving parents may not provide an accurate reflection of the child's pain experience, as it is essential to assess the child's self-reporting.

2. The patient should be taught that an improvement in symptoms will likely be noticed within

• A. 48 hours.
• B. a week to 10 days.
• C. 2 to 3 weeks.
• D. 4 to 6 weeks.

Correct answer: C

Rationale: When taking isoniazid and rifampin for active tuberculosis, patients should be taught that an improvement in symptoms will likely be noticed within 2 to 3 weeks. Choice A (48 hours) is too soon to expect significant improvement in symptoms. Choice B (a week to 10 days) is also too early for noticeable improvement with this medication regimen. Choice D (4 to 6 weeks) is too far out to expect a noticeable improvement in symptoms.

3. Multiple sclerosis manifests as asymmetrical and in different parts of the body because:

• A. Autoreactive lymphocytes are causing diffuse patchy damage to the myelin sheath in the central nervous system.
• B. Acetylcholine receptors are destroyed by immunoglobulin G.
• C. Autoreactive T lymphocytes cause progressive loss of neurons in the substantia nigra.
• D. Cortical motor cells degenerate.

Correct answer: A

Rationale: The correct answer is A. Multiple sclerosis is characterized by the immune system attacking the myelin sheath in the central nervous system. This attack leads to patchy damage on the myelin sheath, resulting in asymmetrical neurological symptoms. Choices B, C, and D are incorrect because they do not accurately describe the pathophysiology of multiple sclerosis. In multiple sclerosis, it is the autoreactive lymphocytes that target and damage the myelin sheath, not acetylcholine receptors, T lymphocytes, or cortical motor cells.

4. A patient is taking alendronate (Fosamax) for osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?

• A. Take the medication with a full glass of water and remain upright for at least 30 minutes.
• B. Take the medication at bedtime to ensure absorption during sleep.
• C. Take the medication with milk to enhance calcium absorption.
• D. Take the medication with food to prevent nausea.

Correct answer: A

Rationale: The correct answer is A. Alendronate should be taken with a full glass of water, and patients should remain upright for at least 30 minutes to prevent esophageal irritation and ensure proper absorption. Taking the medication at bedtime (choice B) is not recommended as it can lead to esophageal irritation when lying down. Taking the medication with milk (choice C) is incorrect as it may interfere with the absorption of alendronate. Taking the medication with food (choice D) is not recommended as it may reduce the effectiveness of the medication.

5. What is the etiology and most likely treatment for myasthenia gravis in a 22-year-old female college student?

• A. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids.
• B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins.
• C. Cerebellar lesions; surgical and immunosuppressive treatment.
• D. Excess acetylcholinesterase production; treatment with thymectomy.

Correct answer: B

Rationale: Myasthenia gravis is characterized by a decline in functioning acetylcholine receptors rather than autoimmune destruction of skeletal muscle cells (Choice A), cerebellar lesions (Choice C), or excess acetylcholinesterase production (Choice D). The most likely treatment for myasthenia gravis involves corticosteroids to reduce inflammation and intravenous immunoglobulins to block the antibodies attacking acetylcholine receptors. Intensive physical therapy and anabolic steroids are not primary treatments for myasthenia gravis.

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