Nursing Elites

1. Which condition is characterized by a progressive loss of muscle strength due to an autoimmune attack on acetylcholine receptors?

• A. Myasthenia gravis
• B. Multiple sclerosis
• C. Amyotrophic lateral sclerosis
• D. Guillain-Barré syndrome

Correct answer: A

Rationale: The correct answer is A: Myasthenia gravis. Myasthenia gravis is characterized by muscle weakness caused by autoimmune attack on acetylcholine receptors at the neuromuscular junction. This results in impaired communication between nerves and muscles. Choice B, Multiple sclerosis, is a condition where the immune system attacks the protective myelin sheath covering the nerves in the central nervous system, leading to communication issues between the brain and the rest of the body. Choice C, Amyotrophic lateral sclerosis, is a progressive neurodegenerative disease affecting motor neurons in the brain and spinal cord, not involving acetylcholine receptors. Choice D, Guillain-Barré syndrome, is an acute condition where the immune system attacks the peripheral nerves, causing muscle weakness and paralysis, but it does not target acetylcholine receptors.

2. After a laparoscopic cholecystectomy, what is the most important instruction the nurse should give the client regarding post-operative care at home?

• A. Avoid lifting heavy objects for at least a week.
• B. Follow a low-fat diet.
• C. Monitor the incision sites for signs of infection.
• D. Resume normal activities as tolerated.

Correct answer: C

Rationale: Monitoring the incision sites for signs of infection is crucial after a laparoscopic cholecystectomy. Infections can lead to serious complications if not detected early. While avoiding heavy lifting and following a low-fat diet are important aspects of recovery, monitoring for infection takes precedence as it directly impacts the client's immediate post-operative well-being. Therefore, option C is the correct answer as it addresses the most critical aspect of post-operative care.

3. The PN is reviewing instructions for the use of pilocarpine eye drops with a client who has glaucoma. The client replies that the drops are used to anesthetize the eye if eye pain is experienced. What action should the PN implement?

• A. Document in the chart that the client understands the correct action and use of eye drops
• B. Reassure the client that the drops will not be needed often since eye pain in glaucoma is not common
• C. Reteach the client about the action of the eye drops to decrease pressure in the eyes
• D. Explain to the client that the eye drops do not anesthetize the eyes but reduce pressure

Correct answer: C

Rationale: Pilocarpine eye drops are used to reduce intraocular pressure in glaucoma, not to anesthetize the eye. The PN should reteach the client about the purpose of the medication to ensure proper use and understanding, which is crucial for effective treatment. Choice A is incorrect because just documenting understanding without addressing the client's misconception is not enough. Choice B is incorrect as it provides incorrect information about the purpose of the eye drops and may lead to further misunderstanding. Choice D is incorrect as it provides inaccurate information stating that the drops provide pain relief, which is not their primary purpose.

4. The PN reviews a client's medication history and learns that the client takes an anticoagulant and has recently started taking phenytoin. Which instruction should the PN provide when assigning the client's morning care to a UAP?

• A. Measure the temperature every 4 hours
• B. Elevate both feet on two pillows
• C. Initiate hourly turning schedule
• D. Protect skin from injury and bruising

Correct answer: D

Rationale: The correct answer is D: Protect skin from injury and bruising. Phenytoin and anticoagulants both increase the risk of bleeding. Protecting the skin from injury and bruising is critical to prevent complications, making it important to instruct the UAP accordingly. Measuring the temperature every 4 hours (Choice A) may not be directly related to the client's medications. Elevating both feet on two pillows (Choice B) is more relevant for issues like edema. Initiating an hourly turning schedule (Choice C) is important for preventing pressure ulcers, but in this case, the priority is to prevent bleeding due to the medications.

5. Before administering a scheduled dose of insulin to a 10-year-old child who is learning diabetic self-care, which information is most important for the PN to ask the child?

• A. How much exercise did the child have today?
• B. Did the child perform a finger stick?
• C. When did the child last urinate?
• D. Has the child eaten recently?

Correct answer: B

Rationale: The correct answer is B: 'Did the child perform a finger stick?' Before administering insulin, it is crucial to check the child's blood glucose level to prevent hypoglycemia. Performing a finger stick blood glucose test provides essential information on the current blood sugar level. Choice A ('How much exercise did the child have today?') is not as critical as monitoring blood glucose levels directly. Choice C ('When did the child last urinate?') is not directly related to the immediate need for insulin administration. Choice D ('Has the child eaten recently?') is important but not as crucial as knowing the current blood glucose level.

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