Nursing Elites

1. A man with gout has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:

• A. asymptomatic
• B. acute flare
• C. the intercritical period
• D. chronic gout

Correct answer: D

Rationale: The correct answer is 'chronic gout.' Chronic gout is characterized by the presence of tophi, which are large, hard nodules that can develop around joints like toes and elbows. These tophi are a sign of longstanding, untreated gout. Choice A, 'asymptomatic,' is incorrect as the presence of tophi indicates a symptomatic phase. Choice B, 'acute flare,' is incorrect as acute flares are characterized by sudden and severe pain, inflammation, and redness in the joints, not the development of tophi. Choice C, 'the intercritical period,' is also incorrect as this phase occurs between acute attacks and is typically asymptomatic, without the presence of tophi.

2. Which disorder is caused by a Staphylococcus aureus organism producing a toxin leading to exfoliation and large blister formation?

• A. Herpes simplex I virus
• B. Bullous impetigo
• C. Necrotizing fasciitis
• D. Cellulitis

Correct answer: B

Rationale: Bullous impetigo is the correct answer because it is caused by a Staphylococcus aureus toxin that leads to exfoliation and the formation of large blisters. Herpes simplex I virus (Choice A) causes cold sores and is not associated with exfoliation and blister formation. Necrotizing fasciitis (Choice C) is a severe skin infection involving the deeper layers of skin and subcutaneous tissues, typically caused by bacteria such as Streptococcus or Clostridium species, not Staphylococcus aureus. Cellulitis (Choice D) is a common bacterial skin infection, but it does not involve exfoliation and blister formation as seen in bullous impetigo.

3. A patient is receiving oral nystatin suspension for a fungal infection of the mouth. Which of the following adverse effects is most likely to be experienced with this form of nystatin?

• A. Local irritation
• B. Burning
• C. Nausea
• D. Urinary urgency

Correct answer: A

Rationale: The correct answer is A: Local irritation. When using oral nystatin suspension for a fungal infection of the mouth, local irritation is the most likely adverse effect that a patient may experience. Nystatin is generally well-tolerated, but some patients may develop local irritation, such as mouth or throat irritation. Choices B, C, and D are less likely adverse effects of oral nystatin suspension. Burning, nausea, and urinary urgency are not commonly associated with nystatin use for a fungal infection of the mouth.

4. A patient's antiretroviral therapy has not been as efficacious as her care team had predicted, and maraviroc (Selzentry) has consequently been added to her drug regimen. The nurse should recognize this drug as belonging to what category of antiretroviral?

• A. Fusion protein inhibitors
• B. Protease inhibitors
• C. CCR5 antagonists
• D. Integrase strand transfer inhibitors

Correct answer: C

Rationale: Women with a history of breast cancer should avoid hormone replacement therapy due to the increased risk of cancer recurrence.

5. A 54-year-old man presents with a temperature of 38.8°C (101.8°F), a racing heart, fatigue, and an upset stomach after spending an afternoon building a deck on a very hot, humid day. The physician assessing the man is performing a differential diagnosis as part of her assessment. Which finding would suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature?

• A. Absence of sweating
• B. Shivering
• C. Lack of thirst
• D. Increased heart rate

Correct answer: B

Rationale: Shivering is a physiological response to fever, as the body attempts to generate heat to increase the internal temperature. Hyperthermia, on the other hand, does not involve shivering. Absence of sweating (choice A) is more indicative of hyperthermia, as the body struggles to cool down without sweating. Lack of thirst (choice C) can be seen in both fever and hyperthermia. Increased heart rate (choice D) can occur in both fever and hyperthermia due to the body's attempt to regulate temperature.

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