Nursing Elites

1. A client with multiple sclerosis (MS) is frustrated by tremors associated with the disease. How should the nurse explain why these tremors occur? Due to the demyelination of neurons that occurs in MS:

• A. there is an imbalance in acetylcholine and dopamine, leading to tremors.
• B. there is a disruption in nerve impulse conduction, causing tremors.
• C. muscles are unable to receive impulses, resulting in tremors.
• D. the reflex arc is disrupted, leading to muscle tremors.

Correct answer: B

Rationale: In multiple sclerosis (MS), demyelination of neurons disrupts nerve impulse conduction. This disruption in nerve impulses can lead to tremors, explaining why the client experiences tremors in MS. Choice A is incorrect because tremors in MS are primarily due to nerve conduction issues, not an imbalance in acetylcholine and dopamine. Choice C is incorrect as it oversimplifies the process; the issue lies in nerve impulses, not the muscle's ability to receive them. Choice D is incorrect as the primary cause of tremors in MS is the disruption in nerve impulse conduction, not the reflex arc being disrupted.

2. A patient with breast cancer is prescribed tamoxifen (Nolvadex). What important information should the nurse provide during patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots.
• B. Tamoxifen may cause weight gain, so patients should monitor their diet.
• C. Tamoxifen may decrease the risk of osteoporosis, so patients should ensure adequate calcium intake.
• D. Tamoxifen may increase the risk of breast cancer, so regular mammograms are essential.

Correct answer: A

Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism, a serious side effect, so patients should be educated about the signs and symptoms of blood clots. This information is crucial as early recognition and prompt treatment of blood clots can prevent complications. Choices B, C, and D are incorrect because tamoxifen is not associated with causing weight gain, decreasing the risk of osteoporosis, or increasing the risk of breast cancer. Providing accurate information is essential for patient safety and understanding.

3. A patient suffers from an autoimmune disorder. Which of the following represents a potential result of a viral infection in a patient with an autoimmune disorder?

• A. Lymphocytes recognize the host's tissue as foreign.
• B. Erythrocytes destroy the T cells of the host.
• C. The involution of the thymus gland increases the risk of infection.
• D. The differential decreases the sedimentation rate.

Correct answer: A

Rationale: In a patient with an autoimmune disorder, a viral infection can trigger an immune response where lymphocytes mistakenly recognize the host's tissue as foreign. This can lead to an exacerbation of the autoimmune condition. Choice B is incorrect because erythrocytes are not responsible for destroying T cells. Choice C is incorrect as thymus involution weakens the immune response, making the patient more susceptible to infections rather than increasing the infection risk. Choice D is unrelated to the potential effects of a viral infection in a patient with an autoimmune disorder.

4. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which component of his 'white matter' has most likely been damaged?

• A. The inner layer (archilayer)
• B. The middle layer (paleolayer)
• C. The outer layer (neolayer)
• D. The reticular formation

Correct answer: C

Rationale: The correct answer is C: The outer layer (neolayer). The white matter of the spinal cord consists of three layers: the outer layer (neolayer), the middle layer (paleolayer), and the inner layer (archilayer). Damage to the outer layer (neolayer) is likely to affect fine motor skills, explaining the loss of fine motor function in the finger and thumb while gross motor movements remain intact. Choices A, B, and D are incorrect as they do not correspond to the specific layer of the white matter that is typically associated with fine motor control.

5. A client is admitted with a suspected aortic dissection. What is the priority nursing intervention?

• A. Administer antihypertensive medications as prescribed.
• B. Prepare the client for emergency surgery.
• C. Administer intravenous fluids to maintain blood pressure.
• D. Monitor the client's urine output closely.

Correct answer: B

Rationale: The correct answer is B: Prepare the client for emergency surgery. Aortic dissection is a life-threatening emergency that often necessitates immediate surgical intervention to prevent rupture and further complications. Administering antihypertensive medications (choice A) may be necessary but is not the priority over surgical intervention. While maintaining blood pressure with intravenous fluids (choice C) is important, the urgent need for surgery takes precedence. Monitoring urine output (choice D) is essential for assessing renal function but is not the priority in this critical situation.

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