Nursing Elites

1. During a flu shot clinic, one of the questions the student nurse asks relates to whether the client has a history of Guillain-Barré syndrome. The client asks, 'What is that?' How should the nursing student reply?

• A. A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles.
• B. Swelling of your arm where you got your flu shot and maybe your eyes and lips had some swelling as well.
• C. A degenerative disease where you have trouble walking without the help of a cane or walker.
• D. Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot.

Correct answer: A

Rationale: The correct answer is A because Guillain-Barré syndrome is an acute immune-mediated polyneuropathy that can lead to paralysis affecting movement on both sides of the body, and in severe cases, involving the respiratory muscles. Choice B is incorrect as it describes local swelling, not the systemic effects of Guillain-Barré syndrome. Choice C is incorrect as it describes a degenerative disease affecting mobility, not an acute immune-mediated condition like Guillain-Barré syndrome. Choice D is incorrect as it describes flu-like symptoms following a flu shot, which is not the same as Guillain-Barré syndrome.

2. 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.

3. In which of the following patients may the administration of a live vaccine be contraindicated?

• A. Patient with renal insufficiency
• B. Patient with hepatic failure
• C. Patient taking steroid therapy
• D. Patient over the age of 65 years

Correct answer: C

Rationale: The correct answer is C. The administration of live vaccines may be contraindicated in patients taking steroid therapy. Steroids can suppress the immune system, reducing the effectiveness of live vaccines. Patients with renal insufficiency or hepatic failure can typically receive live vaccines as these conditions are not direct contraindications. Age alone, such as being over 65 years old, is not a contraindication for live vaccines unless there are other specific health considerations. Therefore, the patient taking steroid therapy is the most likely candidate for whom the administration of a live vaccine would be contraindicated.

4. A male patient with hypogonadism is receiving testosterone therapy. What is the most serious adverse effect the nurse should monitor for?

• A. Increased risk of breast cancer
• B. Increased risk of cardiovascular events
• C. Increased risk of liver dysfunction
• D. Increased risk of prostate cancer

Correct answer: B

Rationale: The correct answer is B: Increased risk of cardiovascular events. Testosterone therapy can lead to an increased risk of cardiovascular events such as heart attacks and strokes, especially in older patients. Monitoring for signs and symptoms of cardiovascular issues is crucial when administering testosterone therapy. Choices A, C, and D are incorrect because testosterone therapy does not typically lead to an increased risk of breast cancer, liver dysfunction, or prostate cancer.

5. A 10-year-old male is stung by a bee while playing in the yard. He experiences a severe allergic reaction and has to go to the ER. The nurse providing care realizes this reaction is the result of:

• A. Toxoids
• B. IgA
• C. IgE
• D. IgM

Correct answer: C

Rationale: The correct answer is C: IgE. A severe allergic reaction, such as the one experienced by the 10-year-old male after being stung by a bee, is mediated by IgE. IgE is involved in common allergic responses, triggering the release of histamine and other chemicals that lead to allergy symptoms. Choice A, Toxoids, are inactivated toxins used in vaccines. Choice B, IgA, is mainly found in mucosal areas and secretions, playing a role in mucosal immunity. Choice D, IgM, is the first antibody produced in response to an infection.

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