Nursing Elites

1. A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis?

• A. Inappropriate activation of apoptosis
• B. Bacterial invasion
• C. Impaired arterial blood supply
• D. Metaplastic cellular changes

Correct answer: C

Rationale: The correct answer is C: Impaired arterial blood supply. Dry gangrene is typically caused by impaired arterial blood supply, leading to tissue death without bacterial infection. Choices A, B, and D are incorrect. Inappropriate activation of apoptosis is not a common cause of dry gangrene. Bacterial invasion usually leads to wet gangrene, not dry gangrene. Metaplastic cellular changes are not directly associated with the development of dry gangrene.

2. A group of nursing students and their professor are engaged in a service learning project and will be caring for patients in Haiti. What medication should be administered to prevent the development of malaria?

• A. Metronidazole (Flagyl)
• B. Oprelvekin (Neumega)
• C. Chloroquine phosphate (Aralen)
• D. Chloroprocaine hydrochloride (Nesacaine)

Correct answer: C

Rationale: The correct answer is Chloroquine phosphate (Aralen). Chloroquine is a medication used to prevent and treat malaria. It works by killing the malaria parasite in the red blood cells. Metronidazole (Flagyl) is an antibiotic used to treat various bacterial and parasitic infections, not malaria. Oprelvekin (Neumega) is a medication used to stimulate platelet production. Chloroprocaine hydrochloride (Nesacaine) is a local anesthetic used for epidural anesthesia. Therefore, Chloroquine phosphate is the appropriate medication for preventing malaria in this scenario.

3. A patient's current medical condition is suggestive of impaired erythropoiesis. Which of the following laboratory studies would be most clinically relevant in diagnosing this health problem?

• A. White blood cell count with differential
• B. RBC, hemoglobin, and hematocrit
• C. INR and aPTT
• D. d-dimer and C-reactive protein

Correct answer: B

Rationale: In this scenario, where impaired erythropoiesis is suspected, the most clinically relevant laboratory studies would focus on red blood cell parameters. Therefore, assessing RBC count, hemoglobin levels, and hematocrit values would provide direct insights into erythropoiesis. Choices A, C, and D are not directly related to erythropoiesis assessment. White blood cell count with a differential is more indicative of immune response and infection. INR and aPTT are coagulation studies, while d-dimer and C-reactive protein levels are more associated with inflammation and thrombotic events.

4. How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?

• A. Administer radioactive cobalamin and measure its excretion time
• B. Measure antigen-antibody immune complexes
• C. Measure serum ferritin and total iron-binding capacity
• D. Administer folate and evaluate folate content in a blood serum sample

Correct answer: A

Rationale: The correct answer is A. To prepare a patient for a Schilling test for pernicious anemia, the nurse should administer radioactive cobalamin and measure its excretion time. This test is specifically designed to assess the absorption of vitamin B12. Choices B, C, and D are incorrect because they do not align with the preparation and procedure of a Schilling test. Measuring antigen-antibody immune complexes, serum ferritin, or total iron-binding capacity, as well as administering folate and evaluating folate content, are not part of the Schilling test protocol.

5. During the cellular stage of acute inflammation, which type of cells arrive first and in great numbers?

• A. Basophils
• B. Lymphocytes
• C. Neutrophils
• D. Platelets

Correct answer: C

Rationale: During the cellular stage of acute inflammation, neutrophils are the first responders. Neutrophils arrive at the site of injury in large numbers to combat pathogens and remove debris. Basophils and lymphocytes are also involved in the inflammatory response, but they are not the first to arrive. Platelets play a role in hemostasis and blood clotting, rather than being the primary cells involved in the initial inflammatory response.

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