Nursing Elites

1. A nurse is conducting an assessment on a client who presents with symptoms that are characteristic of amyotrophic lateral sclerosis (ALS). What assessment finding would be expected in this client?

• A. Reduced reflexes in all four limbs
• B. Decreased cognitive function
• C. Involuntary muscle contractions
• D. Hyperreflexia

Correct answer: D

Rationale: The correct answer is D: Hyperreflexia. In amyotrophic lateral sclerosis (ALS), hyperreflexia is a common assessment finding due to the degeneration of upper motor neurons. This results in an overactive reflex response to stimuli. Reduced reflexes in all four limbs (choice A) are not typically seen in ALS; instead, hyperreflexia is more common. Decreased cognitive function (choice B) is not a primary characteristic of ALS. Involuntary muscle contractions (choice C) are more indicative of conditions such as dystonia or myoclonus, not ALS.

2. A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over her face. Which source is most likely to provide the input that allows for the woman's unique ability?

• A. Special somatic afferent fibers
• B. General somatic afferents
• C. Special visceral afferent cells
• D. General visceral afferent neurons

Correct answer: C

Rationale: The correct answer is C, special visceral afferent cells. These cells are responsible for functions like taste and smell. In individuals with severe visual and auditory deficits, their other sensory abilities, such as touch, can be heightened. Special somatic afferent fibers (choice A) are involved in sensations like touch and vibration from the skin and muscles, but they are not specific to the face. General somatic afferents (choice B) transmit sensory information from the skin, muscles, and joints, but they are not specialized for the unique ability described. General visceral afferent neurons (choice D) are responsible for transmitting sensory information from internal organs, not relevant to the woman's ability to identify individuals through touch on her face.

3. Macular degeneration occurs as a result of:

• A. loss of lens accommodation
• B. detachment of the retina
• C. increased intraocular pressure
• D. impaired blood supply leading to cellular waste accumulation and ischemia

Correct answer: D

Rationale: Macular degeneration is a condition that affects the macula, a part of the retina responsible for central vision. It is primarily caused by impaired blood supply to the macula, leading to cellular waste accumulation and ischemia. This results in the death of photoreceptor cells and ultimately vision loss. Choices A, B, and C are incorrect because macular degeneration is not related to the loss of lens accommodation, detachment of the retina, or increased intraocular pressure. The correct answer directly addresses the underlying pathophysiology of macular degeneration.

4. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What critical contraindication should the nurse review with the patient?

• A. Use of nitrates
• B. Use of antihypertensive medications
• C. History of hypertension
• D. History of peptic ulcer disease

Correct answer: A

Rationale: The correct answer is A: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, which can lead to a dangerous drop in blood pressure. Choice B (Use of antihypertensive medications) is incorrect because antihypertensive medications are not a critical contraindication for sildenafil use. Choice C (History of hypertension) is incorrect as it is not a contraindication for sildenafil; in fact, sildenafil is sometimes used in patients with hypertension. Choice D (History of peptic ulcer disease) is also incorrect as it is not a critical contraindication for sildenafil use.

5. What is the most appropriate nursing diagnosis for the client's son based on the information provided?

• A. Risk for other-directed violence
• B. Disturbed sleep pattern
• C. Caregiver role strain
• D. Social isolation

Correct answer: C

Rationale: The correct answer is 'Caregiver role strain.' In the scenario presented, the son expresses that his father's constant confusion, incontinence, and tendency to wander are intolerable. These challenges indicate that the son is experiencing strain in his role as a caregiver. 'Risk for other-directed violence' is not appropriate because there is no indication of violent behavior. 'Disturbed sleep pattern' is not the most relevant nursing diagnosis given the information provided. 'Social isolation' is not the most appropriate choice as the son's concerns are related to the challenges of caregiving, not isolation.

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