Nursing Elites

1. In Guillain-Barre syndrome, what pathophysiologic process underlies the deficits that accompany the degeneration of myelin in the peripheral nervous system (PNS)?

• A. The destruction of myelin results in a reduction in Schwann cell production in the client's PNS.
• B. The lack of myelin surrounding nerve cells compromises the axonal transport system.
• C. Without remyelination, the axon will eventually die.
• D. A deficit of myelin makes the client more susceptible to infection by potential pathogens.

Correct answer: C

Rationale: In Guillain-Barre syndrome, the destruction of myelin leads to axonal damage. If remyelination does not occur, the axon will eventually degenerate and die, impacting nerve function. Choice A is incorrect because the destruction of myelin does not affect Schwann cell production. Choice B is incorrect as the lack of myelin directly affects the conduction of nerve impulses, not the axonal transport system. Choice D is incorrect as a deficit of myelin does not predispose the client to infections by potential pathogens.

2. A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?

• A. Iron deficiency anemia
• B. Sideroblastic anemia
• C. Pernicious anemia
• D. Hemolytic anemia

Correct answer: C

Rationale: The correct answer is C, Pernicious anemia. Pernicious anemia is associated with a congenital intrinsic factor deficiency, leading to the impaired absorption of vitamin B12. Iron deficiency anemia (Choice A) is not directly related to intrinsic factor deficiency. Sideroblastic anemia (Choice B) is characterized by defective iron uptake by developing erythrocytes and is not linked to intrinsic factor deficiency. Hemolytic anemia (Choice D) involves the premature destruction of red blood cells and is not specifically associated with intrinsic factor deficiency.

3. How can a nurse determine the efficacy of a child's mebendazole treatment for roundworm after 3 weeks?

• A. Liver function tests
• B. Stool for ova and parasites
• C. Colonoscopy or sigmoidoscopy
• D. Rectal swab for culture

Correct answer: B

Rationale: The correct answer is B: Stool for ova and parasites. To assess the efficacy of treatment for roundworm, the nurse would examine the stool for ova (eggs) and parasites. This test helps determine if the infection has been cleared. Choices A, C, and D are incorrect because liver function tests are not commonly used to monitor roundworm treatment efficacy, and colonoscopy/sigmoidoscopy as well as rectal swab for culture are not routine diagnostic tests for assessing the effectiveness of mebendazole treatment for roundworm.

4. A client arrives with symptoms of stroke. What should the nurse assess first?

• A. Level of consciousness
• B. Blood pressure
• C. Pupil reaction
• D. Heart rate

Correct answer: A

Rationale: Assessing the level of consciousness is a critical first step in evaluating a potential stroke. Changes in the level of consciousness can indicate the severity and location of brain damage, helping to guide immediate interventions. Assessing blood pressure, pupil reaction, and heart rate are also important aspects of the assessment in a suspected stroke patient. However, the priority is to quickly determine the client's level of consciousness to assess their neurological status.

5. The early stages of atheroma development are characterized by:

• A. macrophages full of oxidized low-density lipoprotein (LDL; i.e., foam cells) in the intima
• B. accumulation of lipids in the intima (i.e., fatty streak)
• C. accumulation of proteins such as collagen and elastin (i.e., fibrous cap)
• D. development of calcium and a necrotic lipid core

Correct answer: A

Rationale: The correct answer is A. In the early stages of atheroma development, macrophages accumulate oxidized low-density lipoprotein (LDL) and transform into foam cells, leading to the formation of fatty streaks in the intima of blood vessels. This process is a hallmark of the initial stages of atherosclerosis. Choice B is incorrect as it describes the accumulation of lipids in the intima, which is a later event following foam cell formation. Choice C is also incorrect as it refers to the accumulation of proteins forming the fibrous cap, which occurs at a later stage to stabilize the atheroma. Choice D is incorrect as it describes the development of calcium and a necrotic lipid core, typically seen in advanced atherosclerosis rather than the early stages.

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