Nursing Elites

1. When assessing a patient experiencing breakthrough bleeding while taking oral contraceptives, what should the nurse consider?

• A. The possibility of pregnancy
• B. The patient's adherence to the medication schedule
• C. The need for an increased dosage
• D. The effectiveness of the current oral contraceptive

Correct answer: B

Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, it is crucial for the nurse to consider the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of missed doses or inconsistent use, which can decrease the effectiveness of the oral contraceptive. Considering the possibility of pregnancy (Choice A) is important but secondary to assessing adherence. The need for an increased dosage (Choice C) is not typically the first consideration for breakthrough bleeding. Evaluating the effectiveness of the current oral contraceptive (Choice D) is relevant but should come after assessing adherence to the medication schedule.

2. If the client's dorsal columns are not functioning, the nurse will observe which response during neuro testing, where the nurse asks the client to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points?

• A. The client will not be able to distinguish between the two points.
• B. The client will feel only one point of contact.
• C. The client will accurately identify both points.
• D. The client will report no sensation in the touched areas.

Correct answer: A

Rationale: If the client's dorsal columns are not functioning, the ability to distinguish between two closely spaced points is impaired. This results in the client not being able to differentiate between the two points when touched simultaneously. Choice B is incorrect because the client feeling only one point suggests an intact dorsal column function. Choice C is incorrect as accurately identifying both points indicates normal discrimination ability. Choice D is incorrect as reporting no sensation does not correspond to the specific impairment related to dorsal column dysfunction.

3. Rhabdomyolysis can result in serious complications. In addition to muscle pain and weakness, a patient will complain of:

• A. paresthesias.
• B. bone pain.
• C. dark urine.
• D. diarrhea.

Correct answer: C

Rationale: The correct answer is dark urine. Rhabdomyolysis is a condition characterized by the breakdown of muscle tissue, leading to the release of myoglobin into the bloodstream. Myoglobin can cause the urine to appear dark or tea-colored, a condition known as myoglobinuria. This is a classic symptom of rhabdomyolysis. Choices A, B, and D are incorrect as they do not typically present as direct symptoms of rhabdomyolysis. Paresthesias refer to abnormal sensations like tingling or numbness, bone pain is not a primary symptom of rhabdomyolysis, and diarrhea is not a common complaint associated with this condition.

4. A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?

• A. Bronze-colored skin
• B. Decreased iron
• C. Normochromic erythrocytes
• D. Aplastic bone marrow

Correct answer: A

Rationale: The correct answer is A: 'Bronze-colored skin.' Sideroblastic anemia is characterized by excess iron deposition, leading to bronze-colored skin. This occurs due to the abnormal accumulation of iron in tissues. Choices B, C, and D are incorrect because sideroblastic anemia does not typically present with decreased iron levels, normochromic erythrocytes, or aplastic bone marrow.

5. When a healthcare professional is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the healthcare professional calls these erythrocytes:

• A. Hyperchromic
• B. Hypochromic
• C. Macrocytic
• D. Microcytic

Correct answer: B

Rationale: Erythrocytes with an abnormally low concentration of hemoglobin are called hypochromic. Hyperchromic refers to erythrocytes with an abnormally high concentration of hemoglobin. Macrocytic indicates larger than normal red blood cells, while microcytic refers to smaller than normal red blood cells. Therefore, in this scenario, the correct term is hypochromic.

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