Nursing Elites

1. A client with a history of tuberculosis (TB) is experiencing a recurrence of symptoms. Which diagnostic test should the nurse anticipate being ordered?

• A. Sputum culture
• B. Bronchoscopy
• C. Chest x-ray
• D. CT scan of the chest

Correct answer: C

Rationale: A chest x-ray is the most appropriate diagnostic test for a client with a history of tuberculosis experiencing a recurrence of symptoms. A chest x-ray is commonly used to visualize the lungs and check for signs of active tuberculosis, such as abnormal shadows or nodules. While a sputum culture (Choice A) can confirm the presence of TB bacteria, it may not be the initial test ordered for a recurrence. Bronchoscopy (Choice B) and CT scan of the chest (Choice D) are more invasive and usually reserved for cases where the chest x-ray is inconclusive or to further assess complications, rather than as the initial diagnostic test for a recurrence of tuberculosis.

2. A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and decreased sensation in his great toes. Which laboratory values should be assessed?

• A. Hematocrit and hemoglobin
• B. ALT and AST
• C. Urine culture and sensitivity
• D. Erythrocyte count and differential

Correct answer: C

Rationale: In a patient receiving isoniazid (INH) and rifampin (Rifadin) with symptoms of decreased urinary output and decreased sensation in great toes, assessing urine culture and sensitivity is crucial. These symptoms could indicate peripheral neuropathy, a known side effect of isoniazid, and rifampin can cause renal toxicity. Checking for any urinary tract infection or drug-induced nephrotoxicity is important. Choices A, B, and D are incorrect as they do not directly address the symptoms presented by the patient or the potential side effects of the medications mentioned.

3. In which patient 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: The correct answer is A. New onset headaches in older adults, especially if worse at night, may indicate a serious condition like a brain tumor. Choice B describes symptoms commonly seen in migraines. Choice C describes tension-type headaches. Choice D describes symptoms of a menstrual migraine which is not typically associated with a serious underlying disorder.

4. A nurse is teaching a class about immune deficiencies, and a person from the audience asks which cells are affected by severe combined immune deficiency (SCID) syndrome, and the nurse answers:

• A. B cell deficits
• B. T cell deficits
• C. Complement deficits
• D. B and T cell deficits

Correct answer: D

Rationale: The correct answer is D: B and T cell deficits. Severe combined immune deficiency (SCID) syndrome affects both B and T cells, leading to a severe impairment in the immune system's ability to fight infections. Choice A (B cell deficits) is incorrect because SCID affects not only B cells but also T cells. Choice B (T cell deficits) is incorrect as SCID is characterized by deficits in both B and T cells. Choice C (Complement deficits) is incorrect as SCID primarily involves B and T cell deficiencies rather than complement deficiencies.

5. A patient develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has most likely caused the burning and itching?

• A. Cryptococcus neoformans
• B. Candida albicans
• C. Aspergillus
• D. Dermatophytes

Correct answer: B

Rationale: The correct answer is B: Candida albicans. Candida albicans is a common fungal agent responsible for causing vaginal yeast infections characterized by itching and burning. It is known to overgrow in the vagina, especially when the normal vaginal flora is disrupted, such as during antibiotic use. Cryptococcus neoformans is more associated with causing meningitis in immunocompromised individuals, not vaginal symptoms. Aspergillus is more commonly associated with lung infections and allergic reactions, not vaginal infections. Dermatophytes typically cause skin infections like ringworm, not vaginal symptoms.

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