Nursing Elites

1. As you are walking in the park, a huge black Labrador runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpitations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by:

• A. cerebral cortex.
• B. somatic nervous system.
• C. limbic system.
• D. autonomic nervous system.

Correct answer: D

Rationale: The autonomic nervous system controls involuntary bodily functions like heart rate, respiration, and sweating. In the given scenario, the 'fight or flight' response is activated, leading to increased heart rate, palpitations, anxiety, and shaky hands. The cerebral cortex is involved in conscious thought processes and decision-making, not the immediate physiological response observed here. The somatic nervous system regulates voluntary movements, while the limbic system is responsible for emotions and memory, but the autonomic nervous system is primarily responsible for the physiological responses seen in this situation.

2. A patient with a diagnosis of renal failure is being treated with epoetin alfa (Epogen). Frequent assessment of which of the following laboratory values should be prioritized before and during treatment?

• A. AST
• B. C-reactive protein
• C. CBC
• D. ALT

Correct answer: A

Rationale: The correct answer is AST. Epoetin alfa is a medication used to treat anemia associated with chronic renal failure. During treatment with epoetin alfa, it is crucial to monitor AST levels as this medication can potentially lead to liver toxicity. Assessing AST levels before and throughout treatment helps in early detection of any liver abnormalities. C-reactive protein is not specifically related to the use of epoetin alfa in renal failure. While CBC (Complete Blood Count) monitoring is essential during treatment with epoetin alfa to evaluate the response to therapy, prioritizing AST assessment is more critical due to the potential for liver toxicity. ALT monitoring is also important but AST is prioritized in this scenario.

3. 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.

4. A healthcare provider is explaining to a patient the difference between primary and secondary immunodeficiency disorders and explains that secondary immunodeficiencies (select ONE that does not apply):

• A. May develop after viral infections
• B. Develop before birth
• C. May develop following immunosuppressive therapies
• D. Are caused by superimposed conditions

Correct answer: B

Rationale: The correct statements about secondary immunodeficiencies are that they may develop after viral infections, following immunosuppressive therapies, and are caused by superimposed conditions. Choice B ('Develop before birth') is incorrect because secondary immunodeficiencies do not develop before birth. They are acquired later in life. Therefore, the correct answers are A, C, and D.

5. A 5-year-old male presents with low-set ears, a fish-shaped mouth, and involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels. Which of the following diagnoses is most likely?

• A. B cell deficiency
• B. T cell deficiency
• C. Combined immunodeficiency
• D. Complement deficiency

Correct answer: B

Rationale: The correct answer is B: T cell deficiency. The symptoms described in the case, including low-set ears, a fish-shaped mouth, involuntary rapid muscular contraction, and decreased calcium levels, are indicative of DiGeorge syndrome. This syndrome is characterized by T cell deficiency due to thymic hypoplasia. B cell deficiency (Choice A), combined immunodeficiency (Choice C), and complement deficiency (Choice D) do not align with the clinical presentation and laboratory findings provided in the case. Therefore, T cell deficiency is the most likely diagnosis in this scenario.

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