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. A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes as:

• A. Pale in color
• B. Present in various sizes
• C. Able to assume various shapes
• D. Live only a few days

Correct answer: B

Rationale: The correct answer is B: 'Present in various sizes.' Anisocytosis refers to erythrocytes that are present in various sizes, indicating an abnormality in the uniformity of red blood cell size. Choice A is incorrect because anisocytosis does not refer to the color of erythrocytes. Choice C is incorrect as anisocytosis does not involve the shape of erythrocytes. Choice D is incorrect as anisocytosis does not determine the lifespan of erythrocytes.

3. In a patient with HIV infected with Mycobacterium avium complex from an indoor pool, which of the following medications is the recommended treatment for MAC?

• A. Clarithromycin
• B. Isoniazid (INH)
• C. Rifabutin
• D. Azithromycin

Correct answer: A

Rationale: The correct answer is Clarithromycin. Clarithromycin is one of the recommended medications for treating Mycobacterium avium complex (MAC) infections in patients with HIV. It is a macrolide antibiotic that is effective against MAC. Isoniazid (INH) is used to treat tuberculosis, not MAC. Rifabutin is another medication used in the treatment of MAC infections, but clarithromycin is preferred as a first-line agent. Azithromycin is also used in the treatment of MAC infections; however, clarithromycin is more commonly recommended due to its efficacy and safety profile.

4. A patient with breast cancer is prescribed tamoxifen (Nolvadex). What key point should the nurse include in the patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism.
• B. Tamoxifen may cause hot flashes and other menopausal symptoms.
• C. Tamoxifen may cause weight gain and fluid retention.
• D. Tamoxifen may decrease the risk of osteoporosis.

Correct answer: A

Rationale: The correct answer is A: "Tamoxifen may increase the risk of venous thromboembolism." It is crucial for patients to be aware of the signs and symptoms of blood clots while taking tamoxifen. Choice B is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen, but they are not the key point to emphasize. Choice C is incorrect as weight gain and fluid retention are potential side effects of tamoxifen but not the key point for patient education. Choice D is incorrect as tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss.

5. Which statement best conveys an aspect of the role of cerebrospinal fluid (CSF)?

• A. CSF provides immune protection to the brain and spinal cord by serving as a physical barrier.
• B. CSF cushions the brain and spinal cord, protecting them from injury.
• C. CSF plays a limited role in the exchange of nutrients and waste products between the blood and brain.
• D. CSF functions primarily as a medium for the transmission of nerve impulses.

Correct answer: B

Rationale: The correct answer is B. Cerebrospinal fluid primarily cushions the brain and spinal cord, protecting them from injury. Choice A is incorrect because while CSF contributes to the brain's immune environment, its main role is not providing immune protection as a physical barrier. Choice C is incorrect because CSF has a significant role in the exchange of nutrients and waste products, rather than a limited one. Choice D is incorrect as CSF is not primarily a medium for nerve impulse transmission, but rather serves as a protective and supportive fluid.

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