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. When communicating with a client who has cognitive impairment, which of the following will Nurse Dory use?

• A. Complete explanations with multiple details
• B. Pictures or gestures instead of words
• C. Stimulating words and phrases to capture the client’s attention
• D. Short words and simple sentences

Correct answer: D

Rationale: Nurse Dory will use short words and simple sentences when communicating with a client who has cognitive impairment. This approach is effective because it helps improve understanding and comprehension for individuals with cognitive challenges. Choice A is incorrect because complete explanations with multiple details may overwhelm or confuse clients with cognitive impairment. Choice B is not the most effective option as using pictures or gestures instead of words may not always be practical or necessary. Choice C is also not ideal as stimulating words and phrases may cause distraction rather than enhance communication for clients with cognitive impairment.

3. A nursing student having trouble moving her head from side to side is likely experiencing a problem with which type of neurons?

• A. General visceral efferent neurons
• B. Preganglionic neurons
• C. Parasympathetic postganglionic neurons
• D. Pharyngeal efferent neurons

Correct answer: D

Rationale: The correct answer is D: Pharyngeal efferent neurons. Pharyngeal efferent neurons are responsible for controlling head movements, including side-to-side motions. General visceral efferent neurons (Choice A) are involved in innervating smooth muscles and glands in the body's internal organs. Preganglionic neurons (Choice B) are part of the autonomic nervous system and connect the central nervous system to the ganglia. Parasympathetic postganglionic neurons (Choice C) are the second neurons in the parasympathetic nervous system pathway, responsible for innervating target organs. In this case, the issue with moving the head from side to side indicates a problem with the pharyngeal efferent neurons.

4. In a patient with renal failure secondary to an overdose of a nephrotoxic drug, which assessment findings would the nurse recognize as being most suggestive of impaired erythropoiesis?

• A. Frequent infections and low neutrophil levels
• B. Fatigue and increased heart rate
• C. Agitation and changes in cognition
• D. Increased blood pressure and peripheral edema

Correct answer: A

Rationale: Impaired erythropoiesis refers to a decreased production of red blood cells. This can lead to anemia, resulting in symptoms like fatigue and increased heart rate (Choice B). However, the question specifically asks about assessment findings suggestive of impaired erythropoiesis. In this context, frequent infections and low neutrophil levels (Choice A) are more directly related to impaired erythropoiesis due to the impact of anemia on the immune system. Frequent infections are common in anemia due to a compromised immune response, and low neutrophil levels can be seen in conditions of impaired erythropoiesis. Agitation and changes in cognition (Choice C) are more indicative of neurological issues, while increased blood pressure and peripheral edema (Choice D) are commonly associated with renal failure but not specifically related to impaired erythropoiesis.

5. A 21-year-old male is being started on zidovudine (AZT) for the treatment of HIV/AIDS. Which of the following statements made by the patient indicates that he has understood the patient teaching?

• A. “AZT inactivates the virus and prevents recurrence of the disease.”
• B. “AZT therapy may result in the development of AZT-resistant strains.”
• C. “AZT slows the progression of the disease but does not cure it.”
• D. “AZT prevents the occurrence of opportunistic infections.”

Correct answer: C

Rationale: The correct answer is C. When the patient states, “AZT slows the progression of the disease but does not cure it,” it shows an understanding that zidovudine (AZT) does not provide a cure for HIV/AIDS but helps in slowing down the progression of the disease. Choice A is incorrect because AZT does not inactivate the virus or prevent recurrence. Choice B is incorrect as AZT resistance can develop with therapy. Choice D is incorrect because while AZT can help prevent opportunistic infections by boosting the immune system, its primary action is not the prevention of opportunistic infections.

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