Nursing Elites

1. The nurse knows which phenomenon listed below is an accurate statement about axonal transport?

• A. Anterograde and retrograde axonal transport allow for the communication of nerve impulses between a neuron and the central nervous system (CNS).
• B. Materials can be transported to the nerve terminal by either fast or slow components.
• C. The unidirectional nature of the axonal transport system protects the CNS against potential pathogens.
• D. Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.

Correct answer: B

Rationale: The correct answer is B. Axonal transport involves the movement of materials to the nerve terminal by either fast or slow components, which is essential for cell survival. Choice A is incorrect because while anterograde and retrograde axonal transport are involved in the movement of materials, they do not specifically relate to the communication of nerve impulses between a neuron and the CNS. Choice C is incorrect because the unidirectional nature of axonal transport does not primarily function to protect the CNS against pathogens. Choice D is incorrect as axonal transport is responsible for the movement of various materials, not just electrical impulses.

2. A 30-year-old male has been brought to the emergency department by his wife because of a severe headache, nausea, vomiting, and fever. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals a high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs). Which organism is the most likely cause of these findings?

• A. Streptococcus pneumoniae
• B. Neisseria meningitidis
• C. Escherichia coli
• D. Listeria monocytogenes

Correct answer: A

Rationale: The cerebrospinal fluid (CSF) analysis findings of high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs) are classic for bacterial meningitis. Among the choices, Streptococcus pneumoniae is the most likely cause in this case. Streptococcus pneumoniae is a common cause of bacterial meningitis in adults, especially presenting with symptoms such as severe headache, nausea, vomiting, and fever. Neisseria meningitidis is another common cause of bacterial meningitis but is more frequently associated with a different CSF profile. Escherichia coli is a common cause of neonatal meningitis, not typically seen in a 30-year-old male. Listeria monocytogenes is more commonly associated with meningitis in immunocompromised individuals and neonates, and typically presents differently in CSF analysis.

3. During a clinical assessment of a 68-year-old client who has suffered a head injury, a neurologist suspects that the client has sustained damage to her vagus nerve (CN X). Which assessment finding is most likely to lead the physician to this conclusion?

• A. The client has difficulty swallowing.
• B. The client has loss of gag reflex.
• C. The client has an inability to smell.
• D. The client has impaired eye movement.

Correct answer: B

Rationale: The correct answer is B. Damage to the vagus nerve can result in the loss of the gag reflex, which is a key indicator for the neurologist. Difficulty swallowing (Choice A) is more associated with issues related to the glossopharyngeal nerve (CN IX) and hypoglossal nerve (CN XII). An inability to smell (Choice C) is related to the olfactory nerve (CN I), and impaired eye movement (Choice D) is typically associated with damage to the oculomotor nerve (CN III), trochlear nerve (CN IV), or abducens nerve (CN VI), not the vagus nerve.

4. A patient with a history of venous thromboembolism is prescribed hormone replacement therapy (HRT). What should the nurse discuss with the patient regarding the risks of HRT?

• A. HRT is associated with an increased risk of venous thromboembolism, so the patient should be aware of the signs and symptoms of blood clots.
• B. HRT can decrease the risk of osteoporosis, but the patient should also be aware of the increased risk of venous thromboembolism.
• C. HRT may increase the risk of breast cancer, so the patient should undergo regular breast exams.
• D. HRT can improve mood and energy levels, but it also carries a risk of cardiovascular events.

Correct answer: A

Rationale: The correct answer is A. Hormone replacement therapy (HRT) is indeed associated with an increased risk of venous thromboembolism. Therefore, patients should be educated about the signs and symptoms of blood clots and advised to seek immediate medical attention if they occur. Choice B is incorrect because although HRT may decrease the risk of osteoporosis, the focus of concern in this case is the increased risk of venous thromboembolism. Choice C is incorrect as it mentions the risk of breast cancer, which is not the primary concern when discussing HRT with a patient with a history of venous thromboembolism. Choice D is also incorrect as it mentions cardiovascular events, which are not the main focus of risk associated with HRT in this scenario.

5. A patient has been prescribed an estrogen-progestin oral contraceptive. The nurse should emphasize that the risk of thrombophlebitis is most likely in patients who:

• A. Are diabetic.
• B. Smoke cigarettes.
• C. Have a history of hypertension.
• D. Are older than 40.

Correct answer: B

Rationale: The correct answer is B: Smoke cigarettes. Smoking is a significant risk factor for thrombophlebitis, especially when combined with estrogen-progestin contraceptives. Choice A, being diabetic, does not directly increase the risk of thrombophlebitis in this context. Choice C, having a history of hypertension, is not a primary risk factor for thrombophlebitis. Choice D, being older than 40, is not the most likely factor associated with an increased risk of thrombophlebitis in patients taking estrogen-progestin oral contraceptives.

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