Nokea
A patient with Guillain-Barré syndrome asks whether he is going to die as the paralysis spreads toward his chest. In responding to the patient, what should the nurse know to be able to answer this question?
- A. Patients who require ventilatory support almost always die.
- B. Death occurs when nerve damage affects the brain and meninges.
- C. Most patients with Guillain-Barré syndrome make a complete recovery.
- D. If death can be prevented, residual paralysis and sensory impairment are usually permanent.
Correct Answer: C
Rationale: Most patients recover fully, though some may have long-term deficits.
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You are conducting a cranial nerve assessment on a new patient. She cannot feel vibration of the tuning fork when the Weber test is performed. She exhibits a deficit of which cranial nerve?
- A. II
- B. III
- C. VI
- D. VIII
Correct Answer: D
Rationale: The Weber test assesses hearing and involves cranial nerve VIII (vestibulocochlear nerve). If the patient cannot feel vibration, it indicates a deficit in CN VIII. CN II (optic), CN III (oculomotor), and CN VI (abducens) are not involved in hearing.
The posterior column transmits which of the following
- A. Afferent pain and temperature
- B. Afferent tendon stretch impulses
- C. Motor tracts
- D. ?
Correct Answer: B
Rationale: The posterior columns (fasciculus gracilis and cuneatus) transmit proprioceptive and fine touch sensations. These pathways are essential for coordination and balance.
A nurse counseling a patient diagnosed with dissociative identity disorder (DID) should understand that the assessment of highest priority is:
- A. risk for self-harm
- B. cognitive functioning
- C. identification of drug abuse
- D. readiness to reestablish identity or memory
Correct Answer: A
Rationale: The correct answer is A: risk for self-harm. In patients with DID, the primary concern is ensuring their safety due to the high risk of self-harm or suicide. Assessing this risk is crucial for immediate intervention to prevent harm. Choice B, cognitive functioning, may be important but is secondary to ensuring patient safety. Choice C, identification of drug abuse, is relevant but not as urgent as addressing the risk for self-harm. Choice D, readiness to reestablish identity or memory, is important but not as critical as ensuring the patient's safety. Therefore, assessing the risk for self-harm takes precedence in the care of a patient with DID.
Twenty-four hours later Bob is discharged. Which of the following statements would indicate Bob understood your teaching?
- A. Increasing pain in the arm is expected over the next 2 days but if it continues the third day I'll call the physician.
- B. If the fingers of my left hand begin to swell and are colder than those of the right hand, I'll elevate my arm above heart level and call the physician.
- C. Bleeding may appear on the cast today. I'll circle the area and if it continues to increase, I'll call the physician.
- D. I'll immobilize my left hand for 1 week, then begin active flexion-extension exercises and continue until my follow-up visit.
Correct Answer: B
Rationale: Swelling and coldness could indicate impaired circulation, necessitating immediate medical attention.
Which of the following is the causative agent of East African trypanosomiasis?
- A. Trypanosoma cruzi
- B. Trypanosoma vivax
- C. Trypanosoma brucei rhodanese
- D. Trypanosoma brucei gambiense
Correct Answer: C
Rationale: The correct answer is C: Trypanosoma brucei rhodanese. East African trypanosomiasis is caused by Trypanosoma brucei, specifically the subspecies Trypanosoma brucei rhodanese. This parasite is transmitted by tsetse flies and infects humans, causing sleeping sickness. Trypanosoma cruzi (Choice A) causes Chagas disease, not East African trypanosomiasis. Trypanosoma vivax (Choice B) causes a different form of animal trypanosomiasis. Trypanosoma brucei gambiense (Choice D) is responsible for West African trypanosomiasis, not the East African form. Therefore, the correct choice is C.