Nursing Elites

1. During an assessment of a male client suspected of having a disorder of motor function, which finding would suggest a possible upper motor neuron (UMN) lesion?

• A. Hypotonia
• B. Hyperreflexia
• C. Muscle atrophy
• D. Fasciculations

Correct answer: B

Rationale: Hyperreflexia, or exaggerated reflexes, is a common sign of an upper motor neuron (UMN) lesion. An UMN lesion indicates damage to the central nervous system pathways that control movement. Hypotonia (choice A) refers to reduced muscle tone, which is more indicative of lower motor neuron lesions. Muscle atrophy (choice C) suggests long-standing denervation or disuse of muscles. Fasciculations (choice D) are involuntary muscle contractions that can be seen in lower motor neuron lesions, like in amyotrophic lateral sclerosis (ALS), rather than UMN lesions.

2. What is responsible for initiating clonal selection?

• A. B cells
• B. T cells
• C. Antigens
• D. Lymphocytes

Correct answer: C

Rationale: Antigens are the correct answer as they are the molecules that trigger the immune response by binding to specific B or T cells. This binding activates these cells, leading to their proliferation and differentiation to fight off the antigen. B cells and T cells are the responders to antigens, not the initiators of clonal selection. Lymphocytes is a broad term encompassing both B and T cells, so it is not the specific factor responsible for initiating clonal selection.

3. What potential risk should the nurse identify as being associated with infliximab (Remicade) in the treatment of rheumatoid arthritis?

• A. Risk for infection
• B. Risk for decreased level of consciousness
• C. Risk for nephrotoxicity
• D. Risk for hepatotoxicity

Correct answer: A

Rationale: The correct answer is A: Risk for infection. Infliximab (Remicade) is a medication used to treat autoimmune conditions like rheumatoid arthritis. One of the main risks associated with infliximab is an increased susceptibility to infections due to its immunosuppressive effects. This drug works by targeting specific proteins in the body's immune system, which can weaken the body's ability to fight off infections. Choices B, C, and D are incorrect because infliximab is not typically associated with decreased level of consciousness, nephrotoxicity, or hepatotoxicity. It is important for healthcare providers to monitor patients on infliximab for signs of infection and educate them on the importance of infection prevention strategies.

4. Which of the following birthmarks usually fade or regress as the child gets older?

• A. Hemangiomas
• B. Congenital dermal melanocytosis (i.e., Mongolian spots)
• C. Macular stains
• D. Hemangiomas, congenital dermal melanocytosis (i.e., Mongolian spots), and macular stains

Correct answer: D

Rationale: The correct answer is D. Hemangiomas, congenital dermal melanocytosis (i.e., Mongolian spots), and macular stains are birthmarks that usually fade or regress as the child gets older. Hemangiomas are vascular birthmarks that often shrink and fade over time. Congenital dermal melanocytosis (Mongolian spots) are blue-gray birthmarks commonly found on the lower back and buttocks of infants, which typically fade by adolescence. Macular stains, also known as salmon patches, are pink or red birthmarks that usually fade within the first few years of life. Choice D is correct because all the mentioned birthmarks tend to diminish as the child grows, unlike choices A, B, and C which do not fade or regress with age.

5. A client diagnosed with Bell's palsy is receiving discharge teaching from a nurse. Which statement made by the client indicates an understanding of the condition?

• A. I should avoid moving my face excessively to prevent worsening of symptoms.
• B. This condition usually resolves on its own within a few weeks or months.
• C. Bell's palsy is caused by a stroke and requires immediate medical treatment.
• D. I will need to take antiviral medication for the rest of my life to manage this condition.

Correct answer: B

Rationale: The correct answer is B. Bell's palsy typically resolves on its own within a few weeks to months. Choice A is incorrect because gentle facial exercises are often encouraged to prevent muscle weakness. Choice C is incorrect as Bell's palsy is not caused by a stroke but by inflammation of the facial nerve. Choice D is incorrect as antiviral medication is usually given early in the diagnosis but not required for lifelong management.

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