Nursing Elites

1. 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.

2. 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.

3. Which of the following hormones do the kidneys secrete to increase red blood cell production?

• A. Erythropoietin
• B. Insulin and glycogen
• C. Testosterone
• D. Thyroid stimulating hormone

Correct answer: A

Rationale: The correct answer is A: Erythropoietin. The kidneys produce erythropoietin to stimulate the production of red blood cells. Insulin and glycogen are not hormones secreted by the kidneys; insulin is produced by the pancreas, and glycogen is a stored form of glucose. Testosterone is a hormone primarily produced by the testes in males and to a lesser extent in females. Thyroid stimulating hormone is produced by the pituitary gland to regulate thyroid function, not red blood cell production.

4. Why is testosterone therapy prescribed for a 70-year-old man being treated for osteoporosis?

• A. To increase bone density
• B. To reduce the risk of fractures
• C. To enhance sexual performance
• D. To restore testosterone levels

Correct answer: D

Rationale: The primary reason for prescribing testosterone therapy for osteoporosis in men is to restore testosterone levels, not specifically to increase bone density. Testosterone plays a crucial role in maintaining bone density, so by restoring testosterone levels, it indirectly helps in maintaining bone density. Choices A and B are partially correct but do not address the primary reason for testosterone therapy in this context. Choice C is incorrect as the main focus of testosterone therapy in osteoporosis treatment is not related to enhancing sexual performance.

5. A 23-year-old pregnant female visits her primary care provider for her final prenatal checkup. The primary care provider determines that the fetus has developed an infection in utero. Which of the following would be increased in the fetus at birth?

• A. IgG
• B. IgA
• C. IgM
• D. IgD

Correct answer: C

Rationale: The correct answer is IgM. IgM is the first antibody produced in response to an infection and is elevated in a fetus with an in utero infection. IgG is the primary antibody responsible for providing immunity to the fetus and is transferred across the placenta during the third trimester. IgA is mainly found in mucosal areas and colostrum but not significantly elevated in fetal infections. IgD is involved in the development and maturation of B cells but not typically increased in fetal infections.

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