Nursing Elites

1. When administering an immunization, which of the following medications should be available?

• A. Diphenhydramine (Benadryl)
• B. Hydroxyzine (Vistaril)
• C. Physostigmine
• D. Epinephrine

Correct answer: D

Rationale: When administering an immunization, it is essential to have epinephrine available in case of an allergic reaction such as anaphylaxis. Epinephrine is the medication of choice for treating severe allergic reactions due to its ability to reverse the symptoms rapidly. Diphenhydramine and hydroxyzine are antihistamines that can help manage mild allergic reactions but are not the primary medications for severe reactions like anaphylaxis. Physostigmine is not indicated for managing allergic reactions and is used for specific conditions such as anticholinergic toxicity.

2. In the ICU setting, a client transported from surgery following open heart bypass grafting will likely have his or her core temperature measured by:

• A. oral thermometer.
• B. rectal thermometer.
• C. esophageal thermometer.
• D. temporal artery thermometer.

Correct answer: C

Rationale: An esophageal thermometer is commonly used in ICU settings to accurately measure core body temperature, especially in post-surgical patients. The esophageal thermometer provides a more precise measurement of core temperature compared to other methods like oral, rectal, or temporal artery thermometers. In the ICU, accuracy in temperature measurement is crucial for detecting and responding to changes promptly, making the esophageal thermometer the preferred choice in this scenario.

3. The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which teaching point should the physician include when explaining the child's diagnosis to his parents?

• A. Your child may develop breathing difficulties as the disease progresses.
• B. Your child is likely to benefit from physical therapy and exercise.
• C. This condition can be cured with early intervention and treatment.
• D. The disease is caused by inflammation in the muscles, which leads to weakness.

Correct answer: A

Rationale: The correct teaching point that the physician should include when explaining Duchenne muscular dystrophy to the parents is that 'Your child may develop breathing difficulties as the disease progresses.' Duchenne muscular dystrophy is a progressive condition that affects muscle strength, including respiratory muscles, leading to breathing difficulties as the disease advances. Choice B is incorrect because while physical therapy and exercise can help maintain muscle function and mobility, they do not cure the condition. Choice C is incorrect because Duchenne muscular dystrophy is a genetic disorder with no known cure. Choice D is incorrect as Duchenne muscular dystrophy is primarily characterized by a lack of dystrophin protein due to genetic mutations, not inflammation in the muscles.

4. A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which process will accompany the actions of the neurotransmitter in a chemical synapse?

• A. Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
• B. Communication between a neuron and the single neuron it is connected with will be facilitated.
• C. The neurotransmitter will cross gap junctions more readily.
• D. More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

Correct answer: D

Rationale: When serotonin levels increase, more neurotransmitters will cross the synaptic cleft and bind with postsynaptic receptors, facilitating enhanced communication. Option A is incorrect because chemical synapses, unlike electrical synapses, are unidirectional. Option B is incorrect because neurotransmitters impact communication with multiple neurons, not just a single connected neuron. Option C is incorrect because neurotransmitters cross the synaptic cleft, not gap junctions.

5. What is the pathophysiologic process responsible for the decreased glomerular filtration rate in a patient with acute glomerulonephritis?

• A. Decreased renal-induced constriction of the renal arteries
• B. Immune complex deposition, increased capillary permeability, and cellular proliferation
• C. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial hydrostatic pressure
• D. Scar tissue formation throughout the proximal convoluted tubule secondary to toxin-induced collagen synthesis

Correct answer: B

Rationale: The correct answer is B: Immune complex deposition, increased capillary permeability, and cellular proliferation. Acute glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys. This inflammation leads to the deposition of immune complexes, increased capillary permeability, and cellular proliferation, which collectively contribute to a decreased glomerular filtration rate. Choice A is incorrect as decreased renal-induced constriction of the renal arteries would not directly result in decreased glomerular filtration rate. Choice C is incorrect as necrosis of nephrons due to increased kidney interstitial hydrostatic pressure would affect kidney function differently. Choice D is incorrect as scar tissue formation in the proximal convoluted tubule due to toxin-induced collagen synthesis is not a typical feature of acute glomerulonephritis.

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