Nursing Elites

1. 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.

2. A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. On which aspect of the nervous system listed below would her health care providers focus their diagnostic efforts?

• A. The thalamus
• B. The pituitary
• C. The hypothalamus
• D. The midbrain

Correct answer: C

Rationale: The correct answer is C: The hypothalamus. The hypothalamus plays a central role in regulating endocrine and autonomic functions, including fluid and electrolyte balance. In this case, the girl's symptoms of deficits in endocrine and autonomic nervous system control, along with fluid and electrolyte imbalances, point towards dysfunction in the hypothalamus. Choices A, B, and D are incorrect because the thalamus is mainly involved in sensory relay, the pituitary gland regulates various hormones but is controlled by the hypothalamus, and the midbrain is responsible for motor control and arousal, not endocrine or autonomic functions.

3. In which patients would the manifestation of a headache be a sign of a serious underlying disorder?

• A. A 55-year-old man with new onset of headaches that are worse at night and reported mood swings according to his family
• B. A 30-year-old woman with a unilateral throbbing headache with photophobia and nausea
• C. A 60-year-old man with his head feeling full and throbbing and muscle aching around his neck and shoulders
• D. A 40-year-old woman who experiences food cravings, gets irritable, and then develops a pulsatile-like headache on the right side of her head

Correct answer: A

Rationale: In this scenario, the correct answer is the 55-year-old man with new onset headaches that worsen at night and reported mood swings according to his family. These symptoms, especially when combined with nighttime worsening and mood changes, could indicate a serious underlying disorder such as a brain tumor or increased intracranial pressure. Choice B is incorrect as the unilateral throbbing headache with photophobia and nausea is suggestive of migraine headaches, which are usually not associated with serious underlying disorders. Choice C describes symptoms that are more indicative of tension-type headaches rather than a serious underlying disorder. Choice D presents symptoms that are more likely related to hormonal changes and migraines rather than a serious underlying disorder.

4. In a patient with renal failure secondary to an overdose of a nephrotoxic drug, which assessment findings would the nurse recognize as being most suggestive of impaired erythropoiesis?

• A. Frequent infections and low neutrophil levels
• B. Fatigue and increased heart rate
• C. Agitation and changes in cognition
• D. Increased blood pressure and peripheral edema

Correct answer: A

Rationale: Impaired erythropoiesis refers to a decreased production of red blood cells. This can lead to anemia, resulting in symptoms like fatigue and increased heart rate (Choice B). However, the question specifically asks about assessment findings suggestive of impaired erythropoiesis. In this context, frequent infections and low neutrophil levels (Choice A) are more directly related to impaired erythropoiesis due to the impact of anemia on the immune system. Frequent infections are common in anemia due to a compromised immune response, and low neutrophil levels can be seen in conditions of impaired erythropoiesis. Agitation and changes in cognition (Choice C) are more indicative of neurological issues, while increased blood pressure and peripheral edema (Choice D) are commonly associated with renal failure but not specifically related to impaired erythropoiesis.

5. Which of the following women is at highest risk for the development of endometrial cancer?

• A. A 50-year-old postmenopausal woman with a history of high-risk human papillomavirus
• B. A 45-year-old woman who is obese and has a menstrual pattern consisting of periods of amenorrhea and infrequent periods
• C. A 40-year-old woman who is overweight and has hypertension
• D. A 55-year-old woman who smokes

Correct answer: B

Rationale: The correct answer is a 45-year-old woman who is obese and has a menstrual pattern consisting of periods of amenorrhea and infrequent periods. Obesity and prolonged exposure to estrogen unopposed by progesterone due to infrequent ovulation are significant risk factors for endometrial cancer. Choices A, C, and D do not directly correlate with the increased risk of endometrial cancer. Postmenopausal status alone (Choice A), overweight with hypertension (Choice C), and smoking (Choice D) are not the primary risk factors for endometrial cancer.

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