Nursing Elites

1. Which of the following types of vitamin or mineral deficiency can cause megaloblastic anemia and is associated with lower extremity paresthesias?

• A. Vitamin B12
• B. Folate
• C. Iron
• D. Vitamin K

Correct answer: A

Rationale: The correct answer is Vitamin B12. Vitamin B12 deficiency can lead to megaloblastic anemia, a condition characterized by the production of abnormally large and immature red blood cells. Lower extremity paresthesias, such as tingling or numbness, are common neurological symptoms associated with vitamin B12 deficiency. Folate deficiency can also cause megaloblastic anemia but is not typically linked to lower extremity paresthesias. Iron deficiency leads to microcytic anemia, not megaloblastic anemia. Vitamin K deficiency is associated with bleeding tendencies, not megaloblastic anemia or paresthesias.

2. A healthcare professional is documenting the recent vital signs for several clients on an acute medical ward of a hospital. Which hospital client with a noninfectious diagnosis would be most likely to have a fever?

• A. A 71-year-old female with limited mobility, chronic obstructive pulmonary disease (COPD), and vascular dementia
• B. A 33-year-old female with a postoperative deep vein thrombosis and pulmonary embolism
• C. A 51-year-old obese male with hepatic encephalopathy secondary to alcohol abuse
• D. A 71-year-old male with congestive heart failure and peripheral edema

Correct answer: B

Rationale: The correct answer is B. Pulmonary emboli can produce fever even without infection. This is known as a noninfectious cause of fever. Choices A, C, and D do not typically present with fever as a prominent symptom. Limited mobility, COPD, vascular dementia, hepatic encephalopathy, alcohol abuse, congestive heart failure, and peripheral edema are not directly associated with causing fever in the absence of infection, unlike pulmonary embolism.

3. During a home visit to a family of three: a mother, father, and their child, the mother tells the community nurse that the father (who is not present) had hit the child on several occasions when he was drinking. The mother further explains that she has talked her husband into going to Alcoholics Anonymous and asks the nurse not to interfere so her husband won’t get angry and refuse treatment. Which of the following is the best response of the nurse?

• A. The nurse agrees not to interfere if the husband attends an Alcoholics Anonymous meeting that evening.
• B. The nurse commends the mother’s efforts and agrees to let her handle things.
• C. The nurse commends the mother’s efforts and also contacts protective services.
• D. The nurse confronts the mother’s failure to protect the child.

Correct answer: C

Rationale: In this situation, the best response for the nurse is to commend the mother's efforts in seeking help for her husband by encouraging him to attend Alcoholics Anonymous. However, it is crucial for the nurse to also contact protective services to ensure the safety and well-being of the child. Option A is incorrect as it is not appropriate to condition non-interference on the husband attending a meeting that evening. Option B is incorrect because solely letting the mother handle things might put the child at risk. Option D is incorrect as it does not address the immediate need to ensure the child's safety through involving protective services.

4. A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?

• A. Memory loss as a natural consequence of aging
• B. Difficulty coping with physical and psychological changes
• C. Severe cognitive impairment that occurs rapidly
• D. Loss of cognitive abilities, impairing the ability to perform activities of daily living

Correct answer: D

Rationale: The correct answer is D. Dementia is characterized by a loss of cognitive abilities that impairs the individual's capacity to perform activities of daily living. Choice A is incorrect because dementia is not simply memory loss related to aging but involves broader cognitive deficits. Choice B is incorrect as it does not capture the comprehensive cognitive decline seen in dementia. Choice C is incorrect as dementia typically progresses gradually rather than rapidly, and it is not solely about severe cognitive impairment but also impacts daily functioning.

5. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Have you ever given your child any honey or honey-containing products?
• B. Is there any family history of neuromuscular diseases?
• C. Has your baby ever been directly exposed to any chemical cleaning products?
• D. Is there any mold in your home that you know of?

Correct answer: A

Rationale: The correct answer is A. Botulism in infants is often linked to honey consumption. Asking the parents if they have ever given their child any honey or honey-containing products can provide crucial information for the differential diagnosis. This is important because infant botulism is commonly associated with the ingestion of honey contaminated with Clostridium botulinum spores. Choices B, C, and D are less relevant to botulism in infants as they do not directly relate to the typical causes of the condition. Family history of neuromuscular diseases (choice B) may be important for other conditions but not specifically for infant botulism. Direct exposure to chemical cleaning products (choice C) and the presence of mold in the home (choice D) are not typical risk factors for infant botulism.

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