Nursing Elites

1. 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.

2. What function does aldosterone serve in the body?

• A. Aldosterone causes a release of sodium from the body, decreases fluid volume, and decreases blood pressure
• B. Aldosterone causes a retention of sodium in the body, increases fluid volume, and increases blood pressure
• C. Aldosterone causes a release of sodium from the body, increases fluid volume, and decreases blood pressure
• D. Aldosterone enhances intracellular sodium production and lowers blood pressure

Correct answer: B

Rationale: Aldosterone functions by causing the retention of sodium in the body, which results in an increase in fluid volume and blood pressure. Choice A is incorrect because aldosterone actually promotes sodium retention rather than release. Choice C is incorrect as it states that aldosterone decreases fluid volume, which is not accurate. Choice D is incorrect because aldosterone does not enhance intracellular sodium production; instead, it primarily acts on sodium reabsorption in the kidneys.

3. A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause?

• A. Coagulative necrosis
• B. Liquefactive necrosis
• C. Caseous necrosis
• D. Autonecrosis

Correct answer: C

Rationale: The correct answer is C. Caseous necrosis is characteristic of tuberculosis, where the tissue has a soft, cheese-like appearance. Coagulative necrosis involves protein denaturation, liquefactive necrosis is seen in brain infarcts and abscesses, and autonecrosis is not a recognized term in pathology, making them incorrect choices in this scenario.

4. 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.

5. A patient who is taking metronidazole for the past 4 days for the treatment of a parasitic infection reports to the nurse that his most recent dose made him 'flushed, sweaty, and sick in the stomach.' What assessment is most likely to address the cause of this phenomenon?

• A. “Have you experienced any allergic reactions to metronidazole before?”
• B. “Did you drink any alcoholic beverages around the time of taking the drug?”
• C. “Did you take this dose on an empty stomach?”
• D. “Are you currently using any over-the-counter antihistamines?”

Correct answer: B

Rationale: The correct answer is B. Metronidazole can cause a disulfiram-like reaction when taken with alcohol, leading to symptoms such as flushing, sweating, and gastrointestinal upset. Asking the patient about alcohol consumption can help identify if this reaction is due to alcohol interaction. Choice A is incorrect as it focuses on penicillin allergy, which is not relevant to metronidazole. Choice C is less likely to cause the reported symptoms and is not a common concern with metronidazole. Choice D is not directly related to the symptoms described by the patient.

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