Nursing Elites

1. A 70-year-old patient is seen in the family practice clinic. Which of the following vaccines should be administered to prevent shingles?

• A. Zoster vaccine
• B. Haemophilus influenzae Type b (Hib) vaccine
• C. Human papillomavirus (HPV) vaccine
• D. Pneumococcal polyvalent vaccine

Correct answer: A

Rationale: The correct answer is A: Zoster vaccine. The Zoster vaccine is recommended for the prevention of shingles in individuals aged 50 years and older. Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. The vaccine helps reduce the risk of developing shingles and decreases the severity and duration of the illness if it occurs. Choices B, C, and D are incorrect: Haemophilus influenzae Type b (Hib) vaccine is used to prevent infections caused by Haemophilus influenzae type b, Human papillomavirus (HPV) vaccine is used to prevent HPV infections that can lead to cervical cancer and other cancers, and Pneumococcal polyvalent vaccine is used to protect against infections caused by the bacterium Streptococcus pneumoniae.

2. What is the characteristic of the condition of leukemia?

• A. A benign growth of skin cells
• B. A malignant growth of skin cells
• C. A malignant growth of white blood cells
• D. A benign growth of white blood cells

Correct answer: C

Rationale: The correct answer is C: 'A malignant growth of white blood cells.' Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells. These cells are malignant and impair the normal function of healthy blood cells. Choices A, B, and D are incorrect because leukemia does not involve skin cells or benign growths; instead, it specifically refers to the abnormal proliferation of white blood cells.

3. A 55-year-old man presents with a history of fatigue, weight loss, and night sweats. He reports recent onset of a productive cough and hemoptysis. Which condition should the nurse suspect?

• A. Lung cancer
• B. Pneumonia
• C. Tuberculosis
• D. Pulmonary embolism

Correct answer: C

Rationale: The correct answer is C: Tuberculosis. The symptoms described - fatigue, weight loss, night sweats, productive cough, and hemoptysis - are classic manifestations of tuberculosis. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, commonly affecting the lungs but can also involve other organs. **Choice A: Lung cancer** typically presents with symptoms like persistent cough, chest pain, and shortness of breath, but it is less likely in this case due to the presence of hemoptysis. **Choice B: Pneumonia** can present with productive cough, fever, and chest pain, but it is less likely given the chronicity of symptoms and the presence of hemoptysis. **Choice D: Pulmonary embolism** usually presents with sudden onset shortness of breath, chest pain, and can be associated with risk factors like recent surgery or immobility.

4. Rhabdomyolysis can result in serious complications. In addition to muscle pain and weakness, a patient will complain of:

• A. paresthesias.
• B. bone pain.
• C. dark urine.
• D. diarrhea.

Correct answer: C

Rationale: The correct answer is dark urine. Rhabdomyolysis is a condition characterized by the breakdown of muscle tissue, leading to the release of myoglobin into the bloodstream. Myoglobin can cause the urine to appear dark or tea-colored, a condition known as myoglobinuria. This is a classic symptom of rhabdomyolysis. Choices A, B, and D are incorrect as they do not typically present as direct symptoms of rhabdomyolysis. Paresthesias refer to abnormal sensations like tingling or numbness, bone pain is not a primary symptom of rhabdomyolysis, and diarrhea is not a common complaint associated with this condition.

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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