Nursing Elites

1. Matt is a 36-year-old male. In the past year, he has noticed that his limbs sometimes move on their own, and he has also started having trouble remembering things and doing simple calculations. Matt’s father and grandfather were also known to have similar problems during their adulthood. Matt is most likely suffering from:

• A. Phenylketonuria (PKU).
• B. Cystic fibrosis.
• C. Turner syndrome.
• D. Huntington’s disease (HD).

Correct answer: D

Rationale: Matt is exhibiting symptoms typical of Huntington’s disease (HD), a hereditary condition characterized by involuntary movements, cognitive impairment, and behavioral changes. The fact that Matt's father and grandfather had similar issues supports the genetic nature of the disease. Phenylketonuria (PKU) is a metabolic disorder that affects amino acid metabolism, not presenting with the symptoms described. Cystic fibrosis primarily affects the respiratory and digestive systems, not causing the neurological symptoms described. Turner syndrome is a genetic condition affecting females and is not associated with the symptoms described in the case of Matt.

2. A client at 27 weeks of gestation with preeclampsia is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

• A. Urine protein concentration of 200 mg/24 hr.
• B. Creatinine level of 0.8 mg/dL
• C. Hemoglobin level of 14.8 g/dL
• D. Platelet count of 60,000/mm3

Correct answer: D

Rationale: A platelet count of 60,000/mm3 is significantly low and can indicate HELLP syndrome, a severe complication of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome requires prompt medical intervention to prevent serious maternal and fetal complications. The other findings listed are within normal limits or not directly related to the severe condition associated with HELLP syndrome.

3. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?

• A. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
• B. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
• C. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
• D. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

Correct answer: B

Rationale: Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.

4. Humans begin life as a single cell that divides repeatedly. This cell is known as a(n):

• A. zygote.
• B. gonadotrope.
• C. embryo.
• D. chromaffin.

Correct answer: A

Rationale: A zygote is the correct answer. It is the initial cell formed when a sperm cell fertilizes an egg cell, marking the beginning of human development. Choice B, gonadotrope, is incorrect as it refers to a type of hormone-secreting cell in the pituitary gland. Choice C, embryo, is incorrect as it is the stage of development after the zygote has implanted into the uterine wall and undergone initial cell divisions. Choice D, chromaffin, is incorrect as it refers to cells found in the adrenal medulla that produce and store catecholamines.

5. A client who is 5 days postpartum is being taught about signs of effective breastfeeding. Which information should the nurse include in the teaching?

• A. Feeling a tugging sensation when the baby is sucking
• B. Expecting the baby to have two to three wet diapers in a 24-hour period
• C. The baby’s urine should appear dark and concentrated
• D. The breast should stay firm after the baby breastfeeds

Correct answer: A

Rationale: Feeling a tugging sensation while the baby is sucking indicates an effective latch and milk transfer during breastfeeding. This sensation means that the baby is effectively drawing milk from the breast. Choice B is incorrect because infants should ideally have six to eight wet diapers in a 24-hour period to show adequate hydration. Choice C is incorrect as a dark and concentrated urine may indicate dehydration, which is not a sign of effective breastfeeding. Choice D is incorrect as the breast should soften after the baby breastfeeds, indicating that the baby has effectively emptied the breast of milk.

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