Nursing Elites

1. 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.

2. During admission, 82-year-old Mr. Robeson is brought to the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client’s daughter best supports the diagnosis?

• A. “Maybe it’s just caused by aging. This usually happens by age 82.”
• B. “The changes in his behavior came on so quickly! I wasn’t sure what was happening.”
• C. “Dad just didn’t seem to know what he was doing. He would forget what he had for breakfast.”
• D. “Dad has always been so independent. He’s lived alone for years since mom died.”

Correct answer: B

Rationale: The correct answer is B because sudden onset of behavioral changes is a typical symptom of delirium. Delirium is characterized by an acute and fluctuating disturbance in attention, awareness, and cognition. Choice A is incorrect because delirium is not a normal part of aging. Choice C describes memory issues, which can be seen in delirium but are less specific than sudden behavioral changes. Choice D, while it mentions the patient's independence, does not directly support the diagnosis of delirium.

3. A woman has been prescribed Climara, a transdermal estradiol patch. Which of the following should she be instructed by the nurse regarding the administration?

• A. Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.
• B. The application of heat at the patch site will decrease effectiveness and result in pregnancy.
• C. The medication, when exposed to sunlight, can increase the risk of breast cancer.
• D. Exposure of the medication to occasional cold will increase effectiveness with application.

Correct answer: A

Rationale: The correct answer is A. The Climara patch delivers estradiol transdermally, and patients should be instructed to avoid prolonged sun exposure at the patch site due to increased plasma concentrations. Sun exposure can accelerate the absorption of the medication, leading to higher systemic levels than intended. Choices B, C, and D are incorrect because heat at the patch site does not result in pregnancy but may alter absorption rates, there is no direct link between sunlight exposure and breast cancer risk related to this medication, and exposure to cold does not increase effectiveness of the transdermal patch.

4. A client diagnosed with heart failure displays bilateral pitting edema of the lower extremities. Which of the following terms is used to describe this finding?

• A. Contraindication
• B. Sign
• C. Symptom
• D. Subjective data

Correct answer: B

Rationale: The correct answer is 'B. Sign.' In this scenario, bilateral pitting edema is an objective finding that can be observed by others, making it a sign of heart failure. Choice A, 'Contraindication,' refers to a factor that makes a particular treatment or procedure potentially harmful. Choice C, 'Symptom,' is a subjective indication of a condition experienced by the client. Choice D, 'Subjective data,' is information that is reported by the client but cannot be directly observed or measured.

5. What is the primary cause of primary hypercholesteremia?

• A. High-density lipoprotein (HDL) defects
• B. Monogenic mutations, sedentary lifestyle, and high cholesterol diet
• C. Polygenic mutations and environmental factors
• D. Low-density lipoprotein (LDL) receptor mutation with defects in breakdown

Correct answer: Low-density lipoprotein (LDL) receptor mutation with defects in breakdown

Rationale: The correct answer is 'Low-density lipoprotein (LDL) receptor mutation with defects in breakdown.' Primary hypercholesteremia is mainly caused by mutations in the LDL receptor, leading to impaired clearance of LDL cholesterol from the blood. This results in high levels of LDL cholesterol in the bloodstream. Choices A, B, and C are incorrect because they do not directly relate to the primary cause of primary hypercholesteremia.

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