Nursing Elites

1. Elderly persons with pernicious anemia should be instructed:

• A. to increase their dietary intake of foods high in B12.
• B. that they do not need to return for follow-up for at least a month after initiation of treatment.
• C. that oral B12 is safer and less expensive than parenteral replacement.
• D. that diarrhea can be a transient side effect of B12 injections.

Correct answer: D

Rationale: Elderly persons with pernicious anemia, a condition characterized by vitamin B12 deficiency due to lack of intrinsic factor, should be informed about the potential side effects of B12 injections. Diarrhea is a known transient side effect of B12 injections, along with pain and burning at the injection site, and peripheral vascular thrombosis. Increasing dietary intake of B12-rich foods would not be sufficient due to the malabsorption issue in pernicious anemia. Follow-up is essential in managing pernicious anemia, so instructing patients they do not need to return for follow-up is incorrect. While oral B12 may be a suitable option for some cases, it is not the preferred choice for pernicious anemia where malabsorption is the primary issue.

2. Which of the following procedures describes an opening between the colon and abdominal wall?

• A. ileostomy
• B. jejunostomy
• C. colostomy
• D. cecostomy

Correct answer: C

Rationale: A colostomy is an opening between the colon and abdominal wall. An ileostomy is an opening between the ileum and abdominal wall, not the colon. Jejunostomy is an opening between the jejunum and abdominal wall, and cecostomy is an opening into the cecum. The term 'colostomy' specifically refers to the surgical procedure where a part of the colon is brought through the abdominal wall to create a stoma, allowing feces to leave the body. Therefore, the correct answer is colostomy as it accurately describes the opening between the colon and the abdominal wall, distinct from the other options.

3. A nurse suspects a patient is developing Bell's Palsy. The nurse wants to test the function of cranial nerve VII. Which of the following would be the most appropriate testing procedures?

• A. Test the taste sensation over the back of the tongue and activation of the facial muscles.
• B. Test the taste sensation over the front of the tongue and activation of the facial muscles.
• C. Test the sensation of the facial muscles and sensation of the back of the tongue.
• D. Test the sensation of the facial muscles and sensation of the front of the tongue.

Correct answer: B

Rationale: The facial nerve (VII) is responsible for motor function to the face and sensory function to the anterior two-thirds of the tongue. Therefore, to appropriately test the function of cranial nerve VII, the most appropriate testing procedures involve assessing the taste sensation over the front of the tongue (sensory) and activation of the facial muscles (motor). Option B, 'Test the taste sensation over the front of the tongue and activation of the facial muscles,' is the correct answer. Choices A, C, and D are incorrect because they do not involve the correct combination of sensory testing over the front of the tongue and motor activation of the facial muscles, which are key functions associated with cranial nerve VII.

4. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How might bacterial glycocalyx contribute to this?

• A. It protects the bacteria from antibiotic and immunologic destruction.
• B. Glycocalyx neutralizes the antibiotic, rendering it ineffective.
• C. It competes with the antibiotic for binding sites on the microbe.
• D. Glycocalyx provides nutrients for microbial growth.

Correct answer: A

Rationale: Bacterial glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes. It plays a significant role in protecting bacteria by enhancing adherence to surfaces, resisting phagocytic engulfment by white blood cells, and preventing antibiotics from contacting the microbe. Choice A is correct because glycocalyx shields the bacteria from both antibiotics and the immune system, allowing the infection to persist. Choices B, C, and D are incorrect because glycocalyx does not neutralize antibiotics, compete for binding sites with antibiotics, or provide nutrients for microbial growth.

5. Which of the following organs of the digestive system has a primary function of absorption?

• A. stomach
• B. pancreas
• C. small intestine
• D. gallbladder

Correct answer: C

Rationale: The small intestine is the correct answer. It is the primary organ responsible for absorption in the digestive system. The stomach's primary function is to break down food through mechanical and chemical digestion. The pancreas produces digestive enzymes to aid in the breakdown of food. The gallbladder stores bile produced by the liver, which helps in the digestion of fats. However, neither the stomach, pancreas, nor gallbladder play the primary role of absorption in the digestive process, making them incorrect choices.

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