Nursing Elites

1. Cellular swelling is:

• A. Irreversible
• B. Evident early in all types of cellular injury
• C. Manifested by decreased intracellular sodium
• D. None of the above is correct

Correct answer: B

Rationale: Cellular swelling is indeed evident early in all types of cellular injury. This occurs due to the influx of water into the cell, leading to swelling. Choice A is incorrect because cellular swelling is reversible if the injury is not severe. Choice C is incorrect because cellular swelling is not manifested by decreased intracellular sodium; in fact, it is associated with increased intracellular sodium due to water influx. Choice D is incorrect as option B is the correct statement.

2. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Has your child received all recommended vaccinations?
• B. Has your child been feeding poorly or showing signs of constipation?
• C. Has your child been exposed to any sick individuals?
• D. Has your child been displaying signs of respiratory distress?

Correct answer: B

Rationale: The correct answer is B. Poor feeding and constipation are common early symptoms of infant botulism, which is caused by a neurotoxin that impairs muscle function. Option A is unrelated to the presentation of botulism. Option C does not directly relate to the symptoms of botulism. Option D is more indicative of respiratory issues rather than the constellation of symptoms seen in botulism.

3. Multiple sclerosis manifests as asymmetrical and in different parts of the body because:

• A. Autoreactive lymphocytes are causing diffuse patchy damage to the myelin sheath in the central nervous system.
• B. Acetylcholine receptors are destroyed by immunoglobulin G.
• C. Autoreactive T lymphocytes cause progressive loss of neurons in the substantia nigra.
• D. Cortical motor cells degenerate.

Correct answer: A

Rationale: The correct answer is A. Multiple sclerosis is characterized by the immune system attacking the myelin sheath in the central nervous system. This attack leads to patchy damage on the myelin sheath, resulting in asymmetrical neurological symptoms. Choices B, C, and D are incorrect because they do not accurately describe the pathophysiology of multiple sclerosis. In multiple sclerosis, it is the autoreactive lymphocytes that target and damage the myelin sheath, not acetylcholine receptors, T lymphocytes, or cortical motor cells.

4. A nurse is teaching a patient about the use of testosterone gel for the treatment of hypogonadism. What important instruction should the nurse provide?

• A. Apply the gel after showering, and allow it to dry completely before dressing.
• B. Apply the gel to the genitals for maximum absorption.
• C. Apply the gel before bedtime to enhance absorption during sleep.
• D. Apply the gel to the face and neck for improved results.

Correct answer: A

Rationale: The correct instruction is to apply testosterone gel after showering and allow it to dry completely before dressing. This helps prevent the transfer of the gel to others and ensures proper absorption. Choice B is incorrect because the gel should not be applied to the genitals. Choice C is incorrect as there is no specific benefit to applying the gel before bedtime. Choice D is incorrect as the gel should not be applied to the face and neck for the treatment of hypogonadism.

5. A 70-year-old client presents with weakness and sensory loss in the right hand and foot. The client also exhibits speech difficulties. Which condition is the client most likely experiencing?

• A. Transient ischemic attack (TIA)
• B. Brain tumor
• C. Cerebral infarction
• D. Multiple sclerosis

Correct answer: C

Rationale: The correct answer is C: Cerebral infarction (stroke). In this case, the client's symptoms of weakness and sensory loss in the right hand and foot, along with speech difficulties, are indicative of a stroke. These symptoms are commonly seen in individuals experiencing a cerebral infarction, where a blockage in blood flow to the brain leads to neurological deficits. Choices A, B, and D are less likely as transient ischemic attacks (TIAs) typically have temporary symptoms with no permanent damage, brain tumors may present with a different set of symptoms depending on their location, and multiple sclerosis usually presents with a relapsing-remitting pattern of neurological symptoms rather than sudden onset unilateral deficits.

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