Exam 8

In a busy STD clinic on a large university campus, a group of students have developed tetracycline- and penicillin-resistant strains of N. gonorrhoeae. Given these results, the nurse can expect that which of the following medications will be prescribed? A) Single injection of Rocephin (ceftriaxone) B) A 7-day supply of Augmentin (amoxicillin and clavulanate) C) Nizoral (ketoconazole), an antifungal medication D) Fluconazole (Diflucan), for yeast infections

Ans: A Feedback: The current treatment recommendation to combat tetracycline- and penicillin-resistant strains of N. gonorrhoeae is ceftriaxone in a single injection; the other medications are not specific for the treatment of gonorrhea.

Following a collision while mountain biking, the diagnostic workup of a 22-year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis? A) Blood has accumulated between the man's dura and subarachnoid space. B) Vessels have burst between the client's skull and his dura. C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. D) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury.

Ans: A Feedback: A subdural hematoma develops in the area between the dura and the arachnoid space, while epidural hematomas exist between the skull and dura. Intracerebral hematomas are located most often in the frontal or temporal lobe, and the ventricles are not directly involved in a subdural hematoma.

A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiological process has characterized her diagnosis? A) New spongy bone has been formed around her stapes and oval window. B) Her incus, malleus, and stapes have become disconnected from her normal neural pathways. C) Her temporal bone is experiencing unusually rapid resorption. D) Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis.

Ans: A Feedback: Otosclerosis begins with resorption of bone in one or more foci. During active bone resorption, the bone structure appears spongy and softer than normal (i.e., osteospongiosis). The resorbed bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis.

Otitis media (OM), which can occur in any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss? A) Streptococcus pneumoniae B) Acoustic neuromas C) Haemophilus influenzae D) Parainfluenza

Ans: A Feedback: S. pneumoniae is the most common cause of bacterial meningitis that results in sensorineural hearing loss after the neonatal period. Acoustic neuromas are cancers that cause impaired hearing. Parainfluenza and influenza viruses are common viral pathogens in OM.

A 34-year-old male has been diagnosed with testicular cancer after he visited his family physician with a complaint of an enlarged, painful testicle. Biopsy has indicated that his tumor is malignant, and his oncologist believes that the tumor arose in the seminiferous epithelium and is producing a uniform population of cells. What is the client's most likely specific diagnosis? A) Seminoma B) Choriocarcinoma C) Germ cell tumor D) Nonseminoma

Ans: A Feedback: Seminomas are the subtype of germ cell tumors that are most common in the fourth decade and are thought to originate with the seminiferous epithelium and produce a uniform cell population. Nonseminomas tend to produce a variety of cell types, and choriocarcinoma is rare variant of nonseminoma testicular cancer that originates in the placental tissue.

During a physical exam, the nurse practitioner notes that the patient's optic disk is very pale with a larger size/depth of the optic cup. At this point, they are thinking the patient may have A) glaucoma. B) diabetes retinopathy. C) macular degeneration. D) retinal tear.

Ans: A Feedback: The normal optic disk has a central depression called the optic cup. With progressive atrophy of axons caused by increased intraocular pressure, pallor of the optic disk develops, and the size and depth of the optic cup increase. Diabetes retinopathy, macular degeneration, nor retinal tear has these clinical manifestations.

The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder? A) Delayed sleep phase syndrome (DSPS) B) Non-24-hour sleep-wake syndrome C) Advanced sleep phase syndrome (ASPS) D) Chronic insomnia

Ans: A Feedback: The teen's sleep patterns are characteristic of DSPS. Non-24-hour sleep-wake syndrome is characterized by a sleep cycle that greatly exceeds 24 hours, and ASPS is the opposite of DSPS. Chronic insomnia would likely include afternoon and evening drowsiness.

Which of the following is the most likely course of Wernicke syndrome? A) If the symptoms are correctly diagnosed, most of the effects of the disease can be reversed through better nutrition and supplemental thiamine. B) Wernicke syndrome is uniformly fatal, with death most often occurring within a few months of onset. C) Wernicke syndrome has no treatment, but drugs may be used to treat its associated dyskinesias and behavioral disturbances. D) The course of the disease is relentless, and most affected persons will die of infection within 2 to 10 years.

Ans: A Feedback: Wernicke syndrome is caused by a deficiency of thiamine (vitamin B1), and many of the symptoms are reversed when nutrition is improved with supplemental thiamine.

Two nursing students are debating the merits and demerits of infant circumcision. Which of the following statements is most accurate? A) "Circumcised men tend to have a lower incidence of penile cancer." B) "Getting circumcised basically rules out the possibility of getting Peyronie disease later in life." C) "Circumcision reduces pressure on the deep dorsal vein and the dorsal artery, making erection easier later in life." D) "The odds of getting infant priapism fall with circumcision."

Ans: A Feedback:A correlation between circumcision and lower incidence of penile cancer has been noted. Circumcision is unlikely to affect the development of Peyronie disease or priapism, and is not noted to influence the ease of attaining or maintaining erection.

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions 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?"

Ans: A Feedback:Botulism in infants is frequently attributable to honey. Family history is not a relevant consideration given the bacterial etiology, and mold and chemical cleaning products are not known to predispose to botulism toxicity.

A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her long-standing alcohol addiction. The levels and pathways of which of the following neurotransmitters in her body are likely to differ from an individual without addiction? A) Dopamine B) Acetylcholine C) Serotonin D) Norepinephrine

Ans: A Feedback:Dopamine levels are thought to be altered in addiction and possibly contribute to addiction. Acetylcholine, serotonin, and norepinephrine are not noted to play a central role in the neurophysiology of addiction.

Of the following list of medications, which would likely be prescribed to a patient with benign prostatic hyperplasia (BPH) as a way to decrease the prostate size by blocking the effects of androgens on the prostate? A) Finasteride (Proscar), a 5a-reductase inhibitor B) Imdur (isosorbide mononitrate), a vasodilator C) Birth control pills containing both estrogen and progestin D) Leuprolide (Lupron), a gonadotropin-releasing hormone analog

Ans: A Feedback:Finasteride (Proscar), a 5a-reductase inhibitor, reduces prostate size by blocking the effect of androgens on the prostate. Vasodilators, BCPs, and GnRH analogs do not decrease prostate size.

A 70-year-old woman has been brought to the emergency department by her daughter who noticed the woman is weak, confused, and forgetful in recent months, along with uncoordinated movements and visual disturbances at times. Which of the following questions by the physician are most likely to address her probable diagnosis? Select all that apply. A) "What medications is your mother currently taking?" B) "Does your mother drink alcohol?" C) "Does your mother have a history of stroke?" D) "Is your mother facing significant stressors right now?" E) "Is your mother lonely?"

Ans: A, B Feedback: The client's symptoms are characteristic of Wernicke-Korsakoff syndrome, which is associated with alcohol abuse. Medications can cause numerous cognitive and motor disturbances in elderly clients. Prior CVA and stress are less likely to contribute to her symptomatology.

A pregnant teenager has arrived at a free clinic seeking care. She has had no prenatal care and is currently 27 weeks' gestation. Upon testing for a sexually transmitted disease (STD), it is found that she has active T. pallidum (syphilis). Given the fact that she has active syphilis at this stage in her pregnancy, it is very likely her fetus is at risk for: Select all that apply. A) being born prematurely. B) congenital defects. C) unstable blood glucose levels. D) cyanosis in limbs after delivery. E) blindness.

Ans: A, B Feedback:There is rapid transplacental transmission of the organism from the mother to the fetus after 16 weeks' gestation, so that active infection in the mother during pregnancy can produce congenital syphilis in the fetus. Untreated syphilis can cause prematurity, stillbirth, and congenital defects and active infection in the infant. Unstable blood glucose levels can occur with diabetic mothers, and many infants have some acrocyanosis immediately following birth. Blindness from syphilis can occur decades after initial infection, so it would not be present at birth.

A couple has been trying to get pregnant for over 2 years. After infertility testing, the physician has informed the male that he has a low sperm count. The nurse knows which of the following causes of low sperm count may lead to impaired spermatogenesis? Select all that apply. A) Prolonged fever B) Wearing tight briefs rather than boxers C) Undescended testes D) Swimming in cold-water lakes E) Vacationing in a tropical location

Ans: A, B, C Feedback:Prolonged exposure to elevated temperatures, as a result of prolonged fever, tight undergarments, and failure of the testes to descend into the scrotum can result in decreased sperm counts.

A 31-year-old woman and her husband have presented to their family physician due to their inability to conceive a child after trying for the last 18 months. Which of the following will the nurse practitioner want to specifically rule out as potential contributing factors? Select all that apply. A) Cryptorchidism in the husband B) Slow maturation of the endothelial lining after ovulation C) Low levels of LH and FSH in the wife D) Large amounts of clear, stretchy cervical mucus E) Sexually transmitted diseases like gonorrhea or chlamydial infection.

Ans: A, B, C, E Feedback:Cryptorchidism, luteal phase defects, low pituitary hormone levels, and an inability of the tubes to pick up an ovum can all contribute to infertility. A large amount of clear, stretchy cervical mucus is a normal finding. Cervical cultures for gonorrhea, chlamydial infection, and mycoplasmal infection should be obtained and treatment instituted as needed.

While working in a sexually transmitted disease (STD) clinic, the nurse should be aware that which of the following diagnostic tools are available for diagnosing chlamydial infections? Select all that apply. A) Gram stain where polymorphonuclear leukocytes are identified B) Direct fluorescent antibody testing C) Enzyme-linked immunosorbent assay (ELISA) D) Western blot testing E) Nucleic acid amplification tests (NAATs)

Ans: A, B, C, E Feedback:Diagnosis of chlamydial infections takes several forms. The identification of polymorphonuclear leukocytes on Gram stain of penile discharge in the man or cervical discharge in the woman provides presumptive evidence. The direct fluorescent antibody test and enzyme-linked immunosorbent assay that use antibodies against an antigen in the Chlamydia cell wall are rapid tests that are highly sensitive and specific. Nucleic acid amplification tests (NAATs) do not require viable organisms for detection and can produce a positive signal from as little as a single copy of the target DNA or RNA. Western blot is used to verify HIV after a positive ELISA result for HIV.

The health nurse is dealing with a case of untreated chlamydial infection. The nurse suspects the patient has developed Reiter syndrome. Which of the following clinical manifestations would support this diagnosis? Select all that apply. A) Diffuse pinkness of the conjunctiva along with watery and itchy eyes B) Asymmetric complaints of stiffness and pain in knees and sacroiliac joints C) Cervical tissue very friable and bleeds easily D) Pain when urinating E) Fatigue and tiredness from heart valve vegetation

Ans: A, B, D Feedback: The most serious complication of untreated chlamydial infection is the development of Reiter syndrome. This triad of symptoms includes urethritis, conjunctivitis, and arthritis of weight-bearing joints, such as the knees and sacroiliac and vertebral joints. Pain when urinating occurs in both men and women and is associated with urethritis. Women can also develop reactive arthritis, but the male-to-female ratio for this complication is 5:1. The arthritis begins 1 to 3 weeks after the onset of chlamydial infection. The joint involvement is asymmetric, with multiple affected joints and a predilection of the lower extremities. Cervical tissue friability is not part of Reiter syndrome.

Which of the following individuals would be considered at high risk for developing cataracts? Select all that apply. A) An 88-year-old female with osteoporosis and congestive heart failure B) A 51-year-old female whose rheumatoid arthritis is controlled with oral corticosteroids C) A 50-year-old male who takes nebulized bronchodilators four times daily for the management of his emphysema D) A 39-year-old woman with a history of open-angle glaucoma and poorly controlled diabetes E) A 29-year-old artist who spends long hours in sunlight painting landscapes

Ans: A, B, D, E Feedback:Advanced age, steroid use, and sunlight exposure are all significant risk factors for the development of cataracts. Metabolically induced cataracts are caused by disorders of carbohydrate metabolism (diabetes). Use of bronchodilators is not noted to be strongly associated with cataracts.

A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The client has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The client has a 40 pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a -adrenergic-blocking medication. During the nurse's assessment, the man states that he has been unable to maintain his erection in recent months. Which of the following aspects of the man's health problems and treatments would the nurse identify as contributing to his erectile difficulty (ED)? Select all that apply. His A) antihypertensive medications. B) use of bronchodilators. C) hypertension. D) diuretic use. E) smoking history. F) age.

Ans: A, C, E, F Feedback:Hypertension, antihypertensive medications, age, and smoking are all implicated in the etiology of ED. Ischemic heart disease and bronchodilators are less likely to directly contribute to the condition.

A 31-year-old male has been referred to a fertility clinic following a count of 2 million sperm/mL on seminal fluid analysis. Which of the following hormone levels would a clinician want to examine in an effort to ascertain the cause of the client's low sperm count? Select all that apply. A) Luteinizing hormone (LH) B) Adrenocorticotropic hormone (ACTH) C) Follicle-stimulating hormone (FSH) D) Cortisol TESTBANKSELLER.COM E) Somatostatin F) Gonadotropin-releasing hormone (GnRH)

Ans: A, C, F Feedback:LH, FSH, and GnRH are all components of the hypothalamic-pituitary control of spermatogenesis. ACTH, cortisol, and somatostatin are not directly involved in the process.

A 4-year-old boy has had otitis media with effusion (OME) for several weeks, and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM? Select all that apply. A) Reflux of fluid from the boys nose into his middle ear C) Accumulation of cerumen in the external acoustic meatus D) Sensorineural deficits in the auditory control apparatus E) Exposure to respiratory virus

Ans: A, E Feedback:Reflux via the eustachian tubes, IgG deficiency, and exposure to RSV have all been implicated in the development of AOM. Cerumen accumulation in the outer ear, deficient IgM, and sensorineural deficits are unlikely to contribute to AOM.

A nursing student studying obstetrics asks the faculty, "How does the sperm get so much energy to swim up the fallopian tubes?" The instructor responds based on which pathophysiological principle? A) Usually the ejaculation is so powerful that it propels the sperm far up into the fallopian tubes. B) Fructose is secreted by the seminal vesicles and provides energy for motility of the sperm. C) The seminal vesicles secrete fluid for the semen, and they can secrete catecholamines that energize the sperm. D) Estrogen, which is being secreted when the ova are ripe and ready for penetration, assists by attracting the sperm in the right direction.

Ans: B Feedback: The seminal vesicles consist of two highly tortuous tubes that secrete fluid for the semen. Each of the paired seminal vesicles is lined with secretory epithelium containing an abundance of fructose, prostaglandins, and several other proteins. The fructose secreted by the seminal vesicles provides the energy for sperm motility.

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What are the woman's most likely treatment and prognosis? A) Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy. B) Oral antiprotozoals to the patient and sexual partners to help prevent complications. C) Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection. D) Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

Ans: B Feedback: The treatment of choice for Trichomonas vaginalis is oral, metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment, and eradication of the infection is possible with treatment

If a male has a history of impaired blood flow in his vascular system, he may be prone to develop A) premature ejaculation. B) erectile dysfunction. C) penile engorgement. D) vascular clots in pudendal arteries.

Ans: B Feedback: Vascular disease affects male potency because it may impair blood flow to the pudendal arteries or their tributaries, resulting in loss of blood volume with subsequent poor distention of the vascular spaces of erectile tissue. Premature ejaculation is not caused by a vascular problem. Penile engorgement is expected as part of an erection. Vascular clots may relate to a trauma or surgery to the penis

A 26-year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? A) A myoclonic seizure B) A tonic-clonic seizure C) An absence seizure D) A complex partial seizure

Ans: B Feedback:A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of the bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. Absence seizures are nonconvulsive, and complex partial seizures are accompanied by automatisms.

While working at the triage desk in the local emergency department, which of the following patients is likely having a medical emergency and needs to be seen first? A) A 17-year-old high school student who has a red, itchy eye B) A 55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision C) A 45-year-old school teacher complaining of a red eye that is draining yellow secretions D) An infant with red eyes who is irritable and refusing to eat

Ans: B Feedback:Attacks of increased intraocular pressure are manifested by ocular pain and blurred vision caused by corneal edema. Acute angle-closure glaucoma is an ophthalmic emergency. Treatment is directed at reducing the intraocular pressure, usually with pharmacologic agents.

A 30-year-old woman has sought care because of her recurrent photophobia, tearing, and eye irritation. During assessment, her care provider asks about any history of cold sores or genital herpes. What is the rationale for the care provider's line of questioning? A) Herpes simplex virus (HSV) conjunctivitis indicated a need for antiviral rather than antibacterial treatment. B) HSV infection of the cornea is a common cause of corneal ulceration and blindness. C) Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia. D) A history of HSV with eye irritation is suggestive of glaucoma.

Ans: B Feedback:Herpes simplex virus (HSV) keratitis (not conjunctivitis) with stromal scarring is the most common cause of corneal ulceration and blindness in the Western world. Autoinoculation from the eyes to other sites is not common, and glaucoma is not noted to be a consequence or symptom of HSV infection.

If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This patient would be diagnosed as havingA) hyperopia. B) myopia. C) cycloplegia. D) presbyopia.

Ans: B Feedback:If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This condition is called myopia or nearsightedness. People with myopia can see close objects without problems. Hyperopia is farsightedness. Cycloplegia is paralysis of the ciliary muscle, with loss of accommodation. Presbyopia refers to a decrease in accommodation that occurs because of aging.

A 70-year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? A) "Unfortunately there aren't any proven treatments for your condition." B) "There are some exercises that ill teach you to help reorient your inner ear and prevent vertigo." C) "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo." D) "We usually don't actively treat BPPV unless it starts to affect your hearing."

Ans: B Feedback:Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option, and even in the absence of hearing loss, treatment is warranted.

A medical student is assessing a 22-year-old male who has come to the emergency department because of pain and swelling in his scrotum over the past 36 hours. The attending physician has told the student that she suspects epididymitis. Which of the medical student's following questions is most likely to be useful in the differential diagnosis of epididymitis? A) "Do you know if your vaccinations for mumps are up to date?" B) "Have you had unprotected sex in the past?" C) "Do you have a sensation of heaviness in the left side of your scrotum?" D) "Has it been painful when you get an erection lately?"

Ans: B Feedback:Sexually transmitted infections are a common contributing factor to epididymitis. Mumps are more often a precursor to orchitis, and heaviness on the left side is associated with varicocele. Pain with an erection is not a noted symptom of epididymitis.

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? A) Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids B) A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins C) Cerebellar lesions; surgical and immunosuppressive treatment D) Excess acetylcholinesterase production; treatment with thymectomy

Ans: B Feedback:The etiology of myasthenia gravis involves a deficiency of acetylcholine receptors at neuromuscular junctions. Treatment can include corticosteroid therapy and intravenous immunoglobulins. Destruction of skeletal muscle cells, cerebellar lesions, and excess acetylcholinesterase are not noted to underlie the disease.

A care aide at a long-term care facility has informed a resident physician that an 80-year-old woman's eyes appear to be inflamed and that her eyelids are caked with sticky secretions. The woman has been subsequently diagnosed with posterior blepharitis. Which of the following treatments is the physician likely to initiate? A) Surgical repair of the woman's blocked meibomian glands B) Warm compresses to be applied regularly to her eyes in addition to oral antibiotics C) Regularly scheduled cleansing of the woman's eyes with normal saline D) Intravenous steroids coupled with topical antibiotic ointment

Ans: B Feedback:Treatment of posterior blepharitis is determined by associated conjunctival and corneal changes. Initial therapies can include warm compressing of the lids and use of flaxseed or fish oil tablets to provide omega-3 fatty acid benefits to meibomian oil secretions. Long-term, low-dose systemic antibiotic therapy guided by results of bacterial cultures along with short-term topical steroids may also be needed.

After a long and frustrating course of constant vaginal pain, a 38-year-old woman has diagnosed with generalized vulvodynia by her gynecologist. What treatment plan is her physician most likely to propose? A) Alternative herbal therapies coupled with antifungal medications B) Antidepressant and antiepileptic medications C) Lifestyle modifications aimed at accommodating and managing neuropathic pain D) Narcotic analgesia and nonsteroidal anti-inflammatory medications

Ans: B Feedback:Treatment of vulvodynia necessitates a long-term, chronic pain approach; antidepressants and antiepileptic medications are often used. Alternative therapies, standard analgesic regimens, and simple lifestyle modifications are less likely to be effective.

An elderly male patient is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the patient may have a problem with A) kidney stones. B) an enlarged prostate gland. C) blood clots clogging the urethra. D) calcium sediment in the bladder

Ans: B Feedback: Symptoms of obstruction, including dribbling after urinating and the continuous sensation of having to urinate, are most likely due to enlargement of a prostate gland. Kidney stones cause intense flank pain; blood clots are usually associated with trauma or surgery; calcium sediment could imply a kidney stone or be a result of a procedure to break up kidney stones into smaller segments

While educating a mother about the benefits of giving her child the human papilloma virus (HPV) vaccine, gardisil, which of the following statements will the nurse need to clarify for the parent? Select all that apply. The vaccine is A) best administered before the child becomes sexually active. B) 100% effective against development of cervical cancer for her life span. C) effective against the two most common strains of genital warts. D) only recommended for females between the ages of 9 and 26. E) recommended prior to exposure to HPV, and if the child has genital warts, they are already exposed.

Ans: B, D Feedback: The HPV vaccine has decreased the risk of cervical cancer by 97%. Gardisil is one type of HPV vaccine to prevent infection with the HPV subtypes 16, 18, 9, and 11. This vaccine has been approved for girls and boys between 9 and 26 years of age (prior to becoming sexually active) to prevent HPV 6 and 11 genital warts. The vaccine targets the two strains of HPV (16 and 18) responsible for 70% of the cervical cancer. There is no treatment that is 100% effective against cervical cancer.

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a patient having problems in his hand/wrist. In order to test Tinel sign, the nurse should give the patient which of the following directions? A) "Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose." B) "Hold your wrist in complete flexion; keep it in this position for 60 seconds; how does your hand feel after placing it in a neutral position?" C) "I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?" D) "I'm going to tap this tuning fork and place it on the side of your thumb; then tell me what you are feeling in your hand and wrist."

Ans: C Feedback: A positive Tinel sign will help diagnose carpal tunnel syndrome. The patient will have a tingling sensation radiating into the palm of the hand when lightly percussed over the median nerve at the wrist. Answer choice B relates to Phalen sign, which is also a test to help diagnose carpel tunnel syndrome. Answer choice D is not the medical test for carpal tunnel syndrome.

A 68-year-old man has revealed to his care provider that he is distraught over his increasingly frequent inability to maintain an erection. Which of the following teaching points is most warranted? A) "Above the age of 65, erectile dysfunction is largely inevitable and untreatable." B) "With lifestyle modifications like exercise, weight loss, and quitting smoking, you can most likely correct this and prevent it in the future." C) "While this problem is often a part of the aging process, it might be a result of some of the medications that you take." D) "Most often this problem is transient and will resolve with with time."

Ans: C Feedback:The incidence and prevalence of ED increase with age, and medications often contribute to the problem. ED is not inevitable or untreatable, but it is unlikely to spontaneously resolve. Lifestyle modifications can lessen the risk of developing ED but cannot guarantee correction or prevention.

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations? A) Rocky Mountain spotted fever B) Lyme disease C) Encephalitis D) Spinal infection

Ans: C Feedback: Encephalitis represents a generalized infection of the parenchyma of the brain or spinal cord. A virus, such as West Nile virus, usually causes encephalitis although it may be caused by bacteria, fungi, and other organisms. Encephalitis is characterized by fever, headache, and nuchal rigidity. However, more often, people also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Rocky Mountain spotted fever (answer choice A) is a tick-borne disease caused by the bacterium Rickettsia rickettsii and usually begins with a sudden onset of fever and headache. A rash may occur 2 to 5 days after fever onset. Lyme disease (answer choice B) is also a tick-borne disease. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. As the disease progresses, the patient develops bouts of severe joint pain and swelling of the joint. Neurological problems may occur for weeks, months, or even years after the infection and may include inflammation of the membranes surrounding the brain (meningitis). Spinal infections (answer D) can be thought of as a spectrum of diseases comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, and meningitis.

A 54-year-old diabetic patient has come to the urology clinic complaining of erectile dysfunction. His history includes obesity, coronary artery disease that required CABG 3 years ago, hypertension, and gout. The nurse practitioner is reviewing his record in order to prescribe medication. The practitioner is considering prescribing sildenafil (Viagra). Which of the following home medications is contraindicated if taken concurrently with sildenafil? A) Diltiazem (Cardizem), a calcium channel blocker B) Cordarone (amiodarone), an antiarrhythmic C) Imdur (isosorbide mononitrate), a vasodilator D) Lasix (furosemide), a diuretic

Ans: C Feedback: Sildenafil (Viagra) is a selective inhibitor of phosphodiesterase type 5 (PDE-5), the enzyme that inactivates cGMP. This acts by facilitating corporeal smooth muscle relaxation in response to sexual stimulation. The concomitant use of PDE-5 inhibitors and nitrates (Imdur) is absolutely contraindicated because of the risk of profound hypotension. The other medications listed are not nitrates and do not have this adverse reaction.

After being thrown off the back of a bull, the bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as A) tetraplegia. B) quadriplegia. C) paraplegia. D) anterior cord syndrome.

Ans: C Feedback: Tetraplegia and quadriplegia are loss of motor or sensory function after damage to neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as normal. Anterior cord syndrome includes loss of motor function provided by the corticospinal tracts and loss of pain and temperature sensation from damage to the lateral spinothalamic tracts.

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? A) Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions B) Preventing demyelination of the efferent cerebellar pathways C) Increasing the functional ability of the underactive dopaminergic system D) Preventing axonal degradation of motor neurons

Ans: C Feedback:Antiparkinson drugs act by increasing the functional ability of the underactive dopaminergic system. The cerebellar pathways, acetylcholine levels, and axonal degradation are not components of the etiology of Parkinson disease.

As part of the diagnostic workup for a client's long-standing vertigo, a clinician wants to gauge the eye movements that occur in the client. Which of the following tests is the clinician most likely to utilize? A) Romberg test B) Rotational tests C) Electronystagmography (ENG) D) Caloric stimulation

Ans: C Feedback:ENG is an examination that records eye movements in response to vestibular, visual, cervical (vertigo triggered by somatosensory input from head and neck movements), rotational, and positional stimulation. With ENG, the velocity, frequency, and amplitude of spontaneous or induced nystagmus and the changes in these measurements brought by a loss of fixation, with the eyes open or closed, can be quantified. The Romberg test, rotational tests, and caloric stimulation do not allow for these data.

A patient is asked to stand with feet together, eyes open, and hands by the sides. Then the patient is asked to close his eyes while the nurse observes for a full minute. What assessment is the nurse performing? A) Segmental reflex B) Posture C) Proprioception D) Crossed-extensor reflex

Ans: C Feedback:Information from the sensory afferents is relayed to the cerebellum and cerebral cortex and is experienced as proprioception or the sense of body movement and position independent of vision. The knee-jerk reflex is a form of stretch reflex. The crossed-extensor reflex serves to integrate motor movements, so they function in a coordinated manner.

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs A) are an accumulation of small deficits that may eventually equal the effects of a full CVA. B) are a relatively benign sign that necessitates monitoring but not treatment. C) resolve rapidly but may place the client at an increased risk for stroke. D) are caused by small bleeds that can be a warning sign of an impending stroke.

Ans: C Feedback:TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature, and their effects are not normally cumulative. They may require treatment medically or surgically.

A 14-year-old boy has been brought to the emergency department by his mother in excruciating pain that is radiating from his scrotum to his inguinal area. The boy's heart rate is 122 beats/minute, and he has vomited twice before arrival at the hospital. Examination reveals that his scrotum is reddened and slightly swollen, and the testes are firm to touch and tender, with extensive cremaster muscle contraction noted. What is the boy's most likely diagnosis? A) Epididymitis B) Hydrocele C) Testicular torsion D) Varicocele

Ans: C Feedback:The combination of the boy's age, signs, and symptoms is indicative of testicular torsion. Epididymitis normally lacks cremaster muscle involvement, and hydrocele is marked by massive distention of the scrotum. Varicocele is often asymptomatic or marked by heaviness in the scrotum.

The Women's Health Initiative results have led the Institute of Medicine (2010) to recommend which of the following guidelines related to hip fractures in women? A) All postmenopausal women should take 1200 mg of calcium per day to prevent osteoporosis. B) The standard daily recommended amount of vitamin D was increased to 400 IU/day. C) All adults should take 600 IU/day of vitamin D to maintain healthy bones. D) A combination of calcium and vitamin D does not appear to prevent hip fractures.

Ans: C Feedback:The release of data from two clinical trials within the WHI (low-fat dietary patterns, calcium and vitamin D supplementation) has challenged conventional wisdom in other areas. The use of calcium (1000 mg/day) plus vitamin D (200 IU/day) was shown to result in a small but significant improvement in hip bone density but failed to reduce the risk of hip fractures. The IOM recommends that all adults should take 600 IU/day of vitamin D to maintain healthy bones.

A 13-year-old patient undergoing puberty is alarmed to find small, white bumps surrounding the areolae on her nipples. You reassure her that these are a normal sign of her sexual maturation and tell her that they are which of the following? A) Skene glands B) Bartholin glands C) Montgomery tubercles D) Cooper ligaments

Ans: C Feedback:The small bumps or projections on the areolar surface known as Montgomery tubercles are sebaceous glands that keep the nipple area soft and elastic. At puberty and during pregnancy, increased levels of estrogen and progesterone cause the areola and nipple to become darker and more prominent and the Montgomery glands to become more active.

A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms? A) Advanced sleep phase syndrome B) Delayed sleep phase syndrome C) Free-running sleep disorder D) Time zone change syndrome

Ans: D Feedback: All of the symptoms are manifestations of jet lag syndrome. Answer choice A relates to early sleep onset and early arising, where people have trouble staying awake in the evening. Answer choice B relates to difficulty in falling asleep at a conventional hour of night and awakening on time in the morning. Answer choice C relates to a lack of synchronization between the internal sleep-wake rhythm and the external 24-hour day, seen commonly in blind people.

An adult client is experiencing chronic insomnia related to a recent divorce and child custody proceedings. The client is requesting a renewable prescription for "sleeping pills." The nurse knows that which of the following interventions listed below will provide the most beneficial treatment for this client? A) Sedatives and hypnotic drugs will not provide safe relief of the client's health problem. B) The client is suffering from primary insomnia. C) Melatonin supplements will be the safest and most effective long-term pharmacological treatment. D) Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.

Ans: D Feedback: Behavioral therapies may be beneficial in the treatment of insomnia. Sleep hygiene establishing a regular wake-up time to help set the circadian clock and regularity of sleep onset are encouraged. Drugs may be of use in the short term and should be used judiciously rather than completely avoiding them. The efficacy of melatonin is unproven, and his insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.

A care aide at a long-term care facility has left a note for the care director stating that an 82-year-old resident has a grossly distended scrotum and a likely inguinal hernia. On examination, the resident has been diagnosed instead with hydrocele. What will the care team most likely tell the resident and his family about his diagnosis? A) "We'll get you to the hospital quickly, because if this isn't treated, it can result in a blockage in the blood flow to your testes." B) "This isn't a result of your intestine entering your scrotum, but an accumulation of fluid within your testes." C) "This can sometimes result from the lower level of sex hormones that comes with age, so you will likely benefit from a testosterone supplement." D) "While distressing to look at, this condition usually doesn't have any significant consequences and won't need treatment."

Ans: D Feedback: Hydrocele in adult males is normally considered benign condition that does not warrant treatment unless mobility is affected. Fluid accumulates in the space between the tunica vaginalis and tunica albuginea, not within the testes themselves, and hormone therapy is not indicated.

A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the client from infecting others in the future. Which of the following statements by the client demonstrates the best understanding of his health problem? A) "Either me or a partner could end up with an eye infection from chlamydia that could make us blind." B) "Even though I couldn't end up sterile, a woman that I give it to certainly could." C) "Each of the three stages of the disease seems to be worse than the previous one." D) "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it."

Ans: D Feedback: Seventy-five percent of woman with chlamydial infections are asymptomatic. Blindness is a rare complication in adults who live in industrialized countries, and both men and women can become sterile from the effects. Syphilis, not chlamydial infections, has a course of three distinct stages.

A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The client tells the triage nurse that he received eye drops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect? A) Infectious conjunctivitis B) Keratitis C) Corneal trauma D) Angle-closure glaucoma

Ans: D Feedback: Symptoms of acute angle-closure glaucoma are related to sudden, intermittent increases in intraocular pressure. These occur after prolonged periods in the dark, emotional upset, and other conditions that cause extensive and prolonged dilation of the pupil. Administration of pharmacologic agents such as atropine that cause pupillary dilation (mydriasis) also can precipitate an acute episode of increased intraocular pressure in persons with the potential for angle-closure glaucoma. Attacks of increased intraocular pressure are manifested by ocular pain and blurred or iridescent vision. The man's symptomatology is not characteristic of conjunctivitis, corneal trauma, or keratitis.

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced? A) Anterior cord syndrome B) Brown-Séquard syndrome C) Central cord syndrome D) Conus medullaris syndrome

Ans: D Feedback:Functional deficits resulting from conus medullaris syndrome usually result in flaccid bowel and bladder and altered sexual function. Sacral segments occasionally show preserved reflexes if only the conus is affected. Motor function in the legs and feet may be impaired without significant sensory impairment. Anterior cord syndrome and Brown-Séquard syndrome include a loss of pain and temperature sensation, while central cord syndrome manifests in spastic paralysis and is more common among older adults.

A 30-year-old woman has presented to her family doctor complaining of three distressing episodes over the last several months during which she got extremely dizzy, had loud ringing in her ears, and felt like her ears were full of fluid. She states that her hearing diminishes, and she feels nauseous during these episodes. What diagnosis is the physician most likely to first suspect? A) Acute otitis media B) Acute vestibular neuronitis C) Benign paroxysmal positional vertigo (BPPV) D) Ménière disease

Ans: D Feedback:Ménière disease is characterized by fluctuating episodes of tinnitus, feelings of ear fullness, and violent rotary vertigo that often renders the person unable to sit or walk. There is a need to lie quietly with the head fixed in a comfortable position, avoiding all head movements that aggravate the vertigo. Symptoms referable to the autonomic nervous system, including pallor, sweating, nausea, and vomiting, usually are present. The more severe the attack, the more prominent are the autonomic manifestations. A fluctuating hearing loss occurs with a return to normal after the episode subsides. Her symptomatology is not characteristic of AOM, acute vestibular neuronitis, or BPPV.

A 39-year-old male client has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis? A) Normal levels of free testosterone; low levels of total testosterone B) Low free testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels C) Low levels of gonadotropin-releasing hormone (GnRH) D) Low testosterone levels; high levels of LH and FSH

Ans: D Feedback:Primary hypogonadism is associated with a defect in the testicular production of testosterone normally accompanied by high levels of the hormonal precursors. Free testosterone levels would not be normal given the client's diagnosis. Low GnRH levels are associated with tertiary hypogonadism.

A woman has gone to her gynecologist complaining of pain during intercourse. The physician orders a maturation index on her vaginal scrapings. The results return an index of 75-25-0. The nurse can interpret this to mean A) she is in the beginning of cervical cancer. B) she is in the prime of her reproductive years. C) she is in a perimenopausal phase. D) she is experiencing postmenopausal vaginal dryness.

Ans: D Feedback:The vaginal scrapings are used for a test, the maturation index, that examines the cellular structure and configuration of the vaginal epithelial cells. Typically, this index is 0-40-60 during the reproductive years. With diminished estrogen levels, there is a shift to the left, producing an index of 30-40-30 during the perimenopausal period, and an index of 75-25-0 occurs during the postmenopausal period

A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition was a corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom? A) Burning B) Itching C) Photophobia D) Severe pain

Ans: D Feedback:While burning, itching, and photophobia are all important symptoms of conjunctivitis, severe pain suggests corneal rather than conjunctival disease.

A 55-year-old male has presented to the emergency department because he is alarmed at the genitourinary symptoms he has experienced over the last several days. He reveals that he has had a number of new sexual relationships during a tropical vacation that ended 5 days ago. Over the last several days, he has had increasing pain in his urethra and a creamy yellow discharge from his penis. For the last 2 days, the discharge has been occasionally blood tinged. What differential diagnosis would be the care team's first priority? A) Chancroid B) Syphilis C) Chlamydia D) Gonorrhea

Ans: D Feedback: The rapid onset and bloody penile discharge that the client cites are characteristics of gonorrhea. Neither the onset nor the symptomatology matches syphilis or chancroid, and Chlamydia typically takes longer to manifest and does not normally include bloody discharge.