Nursing Elites

1. The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which teaching point should the physician include when explaining the child's diagnosis to his parents?

• A. Your child may develop breathing difficulties as the disease progresses.
• B. Your child is likely to benefit from physical therapy and exercise.
• C. This condition can be cured with early intervention and treatment.
• D. The disease is caused by inflammation in the muscles, which leads to weakness.

Correct answer: A

Rationale: The correct teaching point that the physician should include when explaining Duchenne muscular dystrophy to the parents is that 'Your child may develop breathing difficulties as the disease progresses.' Duchenne muscular dystrophy is a progressive condition that affects muscle strength, including respiratory muscles, leading to breathing difficulties as the disease advances. Choice B is incorrect because while physical therapy and exercise can help maintain muscle function and mobility, they do not cure the condition. Choice C is incorrect because Duchenne muscular dystrophy is a genetic disorder with no known cure. Choice D is incorrect as Duchenne muscular dystrophy is primarily characterized by a lack of dystrophin protein due to genetic mutations, not inflammation in the muscles.

2. Identify which conditions are due to excessive immune response.

• A. Allergies and onychomycosis
• B. Type II diabetes and smallpox
• C. Chronic renal failure and macular degeneration
• D. Allergies and rheumatoid arthritis

Correct answer: D

Rationale: The correct answer is D: Allergies and rheumatoid arthritis. Allergies are caused by an excessive immune response to harmless substances, while rheumatoid arthritis is an autoimmune disorder where the immune system attacks the body's tissues, leading to inflammation and joint damage. Choices A, B, and C are incorrect. Onychomycosis is a fungal infection of the nails, Type II diabetes is a metabolic disorder not primarily related to immune response, smallpox is a viral infection, chronic renal failure is a kidney condition, and macular degeneration is an eye disorder, none of which are directly linked to excessive immune response.

3. A patient is taking a statin for hyperlipidemia. What important instruction should the nurse provide to the patient?

• A. Take the medication at night to avoid muscle pain.
• B. Take the medication in the morning to ensure it works throughout the day.
• C. Avoid consuming alcohol while taking this medication.
• D. Take the medication with a high-fat meal to increase absorption.

Correct answer: A

Rationale: The correct answer is to instruct the patient to take the medication at night to avoid muscle pain. Statins are known to potentially cause muscle pain or weakness; taking the medication at night can help reduce the incidence of these side effects. Option B is incorrect because the timing of statin administration is not related to its effectiveness throughout the day. Option C is a general precaution when taking medications but not the most important instruction specific to statins. Option D is incorrect as taking the medication with a high-fat meal can actually decrease its absorption.

4. A patient is taking alendronate (Fosamax) for the treatment of osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?

• A. Take the medication with food to avoid gastrointestinal upset.
• B. Take the medication in the morning with a full glass of water and remain upright for at least 30 minutes.
• C. Take the medication before bed to ensure absorption during sleep.
• D. Take the medication with milk to enhance calcium absorption.

Correct answer: B

Rationale: The correct answer is B. Alendronate should be taken in the morning with a full glass of water and the patient should remain upright for at least 30 minutes. This is important to prevent esophageal irritation and ensure proper absorption of the medication. Choice A is incorrect because alendronate should not be taken with food as it can decrease its absorption. Choice C is incorrect as taking the medication before bed increases the risk of esophageal irritation and reduces absorption due to lying down. Choice D is also incorrect because taking alendronate with milk or other calcium-rich foods can decrease its absorption.

5. After a thoracentesis on a client with a pleural effusion, which nursing intervention is most important post-procedure?

• A. Monitor for signs of infection.
• B. Assess for signs of bleeding or hematoma.
• C. Monitor vital signs and respiratory status.
• D. Instruct the client to rest and limit physical activity.

Correct answer: B

Rationale: The correct answer is to assess for signs of bleeding or hematoma. After a thoracentesis, it is crucial to monitor for any bleeding or hematoma formation at the puncture site, as this can lead to complications. Monitoring for signs of infection (Choice A) is essential but is usually a delayed concern compared to the immediate risk of bleeding post-procedure. While monitoring vital signs and respiratory status (Choice C) is important, assessing for bleeding takes precedence to address any immediate complications. Instructing the client to rest and limit physical activity (Choice D) is relevant for general post-procedure care but is not the most critical intervention in this scenario.

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