Nursing Elites

1. What instruction should the nurse include in this patient's health education regarding chloroquine phosphate (Aralen) for malaria prophylaxis?

• A. “Take your pill on the same day each week.”
• B. “Watch out for any unusual rash on your trunk and arms, but this isn't cause for concern.”
• C. “Remember to take your chloroquine on an empty stomach.”
• D. “We'll provide you with enough syringes and teach you how to inject the drug.”

Correct answer: A

Rationale: The correct instruction for the nurse to include in this patient's health education regarding chloroquine phosphate (Aralen) for malaria prophylaxis is to “Take your pill on the same day each week.” This is essential because chloroquine is typically taken once a week on the same day to ensure consistent protection against malaria. Choice B is incorrect because while rashes are a possible side effect of chloroquine, they are not a usual occurrence and should be reported to the healthcare provider. Choice C is incorrect because chloroquine does not need to be taken on an empty stomach. Choice D is incorrect as chloroquine is typically administered orally, not by injection.

2. A 25-year-old woman who works as an air traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis?

• A. Migraine headache
• B. Cluster headache
• C. Temporomandibular joint syndrome
• D. Sinus headache

Correct answer: C

Rationale: The most likely diagnosis for the 25-year-old woman who works as an air traffic controller and presents with facial pain and severe headache that sometimes radiates to her neck or ear, aggravated by stress, is Temporomandibular joint syndrome. This syndrome involves pain in the jaw joint and the muscles controlling jaw movement, which can radiate to the surrounding areas like the neck and ear. Stress and clenching of the jaw commonly exacerbate the symptoms. Migraine headache (choice A) typically presents with other symptoms like nausea, sensitivity to light or sound, and can be triggered by various factors, not just stress. Cluster headache (choice B) is characterized by severe, unilateral pain around the eye with associated autonomic symptoms. Sinus headache (choice D) is usually associated with sinus congestion or infection, presenting with facial pressure or pain, often worsened by bending forward.

3. During surgery, the anesthesia personnel notice the client is having a steady rise in end-tidal carbon dioxide level. At this time, the nurse anesthetist begins to assess the client for malignant hyperthermia. The initial (priority) assessment for this disorder may include:

• A. measuring serum potassium levels.
• B. monitoring for muscle rigidity.
• C. evaluating renal function.
• D. checking arterial blood gases.

Correct answer: B

Rationale: The correct answer is B: monitoring for muscle rigidity. Muscle rigidity is a hallmark sign of malignant hyperthermia, a life-threatening condition triggered by certain anesthetics. Monitoring for this sign is critical in the early identification of the condition. Choices A, C, and D are not the initial priority assessments for malignant hyperthermia. Measuring serum potassium levels, evaluating renal function, and checking arterial blood gases are not specific initial assessments for malignant hyperthermia and would not aid in its early identification.

4. 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.

5. What specific instructions should the nurse provide for proper administration of alendronate (Fosamax) in a patient with osteoporosis?

• A. Take the medication with milk to enhance calcium absorption.
• B. Take the medication with a full glass of water and remain upright for at least 30 minutes.
• C. Take the medication at bedtime to ensure absorption during sleep.
• D. Take the medication with food to prevent gastrointestinal upset.

Correct answer: B

Rationale: The correct answer is to take alendronate with a full glass of water and remain upright for at least 30 minutes. This is essential to prevent esophageal irritation and ensure proper drug absorption. Choice A is incorrect as alendronate should not be taken with milk due to potential interactions. Choice C is incorrect as there is no need to take the medication at bedtime specifically. Choice D is incorrect as taking alendronate with food can decrease its absorption.

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