Nursing Elites

1. Which immunoglobulin presents the first challenge to the antigen?

• A. IgA
• B. IgG
• C. IgM
• D. IgE

Correct answer: C

Rationale: IgM is the first immunoglobulin to challenge the antigen during an immune response. IgM is the primary antibody produced during the initial or primary immune response. It is efficient in agglutination and complement activation, making it crucial in the early stages of defense. IgA is mainly found in mucosal areas and secretions. IgG is the most abundant antibody in circulation and is involved in secondary immune responses. IgE is primarily associated with allergic reactions and parasitic infections. Therefore, IgM is the correct choice as it acts first during the immune response, while the other immunoglobulins have different roles and functions.

2. Ivermectin (Stromectol) appears on a list of a patient's recent medications. The nurse who is reviewing the medications is justified in suspecting that the patient may have been receiving treatment for a parasitic infection with

• A. Entamoeba histolytica.
• B. Giardia lamblia.
• C. Strongyloides stercoralis.
• D. Plasmodium falciparum.

Correct answer: C

Rationale: Ivermectin (Stromectol) is commonly used to treat parasitic infections, particularly Strongyloides stercoralis. This parasitic infection is known to respond well to Ivermectin therapy. Entamoeba histolytica causes amoebiasis and is typically treated with antiprotozoal drugs like metronidazole, not Ivermectin. Giardia lamblia is a protozoan parasite causing giardiasis, which is usually treated with medications like metronidazole or tinidazole, not Ivermectin. Plasmodium falciparum is a malaria-causing parasite and is not treated with Ivermectin but with antimalarial medications like chloroquine or artemisinin-based combination therapies.

3. What clinical manifestations would the nurse expect to find in a client who is experiencing anaphylaxis?

• A. Dilated bronchioles, constriction of peripheral blood vessels, decreased capillary permeability
• B. Asthma, deep vein thrombosis, hepatic encephalopathy
• C. Narrowing of the bronchioles, dilation of the peripheral blood vessels, increased capillary permeability
• D. Left-sided heart failure, pulmonary embolism, urinary tract infection

Correct answer: C

Rationale: In anaphylaxis, the client would present with narrowing of the bronchioles, dilation of the peripheral blood vessels, and increased capillary permeability. These manifestations lead to symptoms such as difficulty breathing, low blood pressure, and swelling. Choices A, B, and D are incorrect because they do not describe the typical clinical manifestations of anaphylaxis.

4. How should rifampin most likely be administered to a patient diagnosed with tuberculosis?

• A. Orally, with food
• B. Orally, on an empty stomach
• C. Intramuscularly
• D. Intravenously, as a bolus

Correct answer: A

Rationale: Rifampin is typically administered orally, and it is recommended to be taken with food to enhance its absorption and reduce gastrointestinal side effects. Administering rifampin intramuscularly or intravenously is not the standard route of administration for this medication used in tuberculosis treatment.

5. A 51-year-old woman has the following clinical findings: thin hair, exophthalmos, hyperreflexia, and pretibial edema. These findings are consistent with:

• A. Subacute thyroiditis.
• B. Autoimmune thyroiditis.
• C. Graves disease.
• D. Hashimoto’s disease.

Correct answer: C

Rationale: The clinical findings of thin hair, exophthalmos, hyperreflexia, and pretibial edema are classic features of Graves disease, an autoimmune disorder that results in hyperthyroidism. Exophthalmos (bulging eyes) and pretibial edema (swelling in the lower legs) are particularly associated with Graves disease due to the autoimmune stimulation of the thyroid gland, leading to increased thyroid hormone production. Subacute thyroiditis (Choice A) typically presents with neck pain and tenderness, while autoimmune thyroiditis (Choice B) is commonly known as Hashimoto's thyroiditis, which presents with hypothyroidism symptoms. Hashimoto's disease (Choice D) is characterized by goiter and hypothyroidism, which contrasts with the hyperthyroidism seen in this patient.

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