Nokea
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. Has your child received all recommended vaccinations?
- B. Has your child been feeding poorly or showing signs of constipation?
- C. Has your child been exposed to any sick individuals?
- D. Has your child been displaying signs of respiratory distress?
Correct Answer: B
Rationale: The correct answer is B. Poor feeding and constipation are common early symptoms of infant botulism, which is caused by a neurotoxin that impairs muscle function. Option A is unrelated to the presentation of botulism. Option C does not directly relate to the symptoms of botulism. Option D is more indicative of respiratory issues rather than the constellation of symptoms seen in botulism.
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A client with multiple sclerosis (MS) is experiencing a relapse. Which of the following factors is most likely contributing to the relapse?
- A. Taking an over-the-counter multivitamin
- B. Experiencing high levels of emotional stress
- C. Getting a flu shot
- D. Engaging in strenuous physical activity
Correct Answer: B
Rationale: Emotional stress can trigger a relapse in multiple sclerosis by exacerbating symptoms. While taking an over-the-counter multivitamin and getting a flu shot are generally safe, they are not typically known to trigger MS relapses. Engaging in strenuous physical activity, if done carefully, can actually have benefits for individuals with MS by improving strength and mobility, so it is less likely to be the cause of a relapse.
A patient with a complex medical history is considering the use of oral contraceptives. The nurse should be aware that many antibiotics and antiseizure medications cause what effect when combined with oral contraceptives?
- A. Increased risk of pregnancy
- B. Increased blood pressure
- C. Increased risk of thromboembolism
- D. Increased gastric acid
Correct Answer: A
Rationale: The correct answer is A: Increased risk of pregnancy. Certain antibiotics and anticonvulsants can decrease the effectiveness of oral contraceptives by inducing liver enzymes that metabolize the hormones more quickly. This interaction can lead to a decreased contraceptive effect, thereby increasing the risk of pregnancy. Choices B, C, and D are incorrect as they do not directly relate to the effect of antibiotics and antiseizure medications on oral contraceptives.
What long-term risks should the nurse discuss with a patient starting on hormone replacement therapy (HRT)?
- A. HRT is associated with increased risks of cardiovascular events and breast cancer, so these risks should be discussed with the patient.
- B. HRT can improve mood and energy levels, but it also increases the risk of osteoporosis.
- C. HRT can increase the risk of venous thromboembolism, so patients should undergo regular screening.
- D. HRT decreases the risk of fractures, but it also increases the risk of developing diabetes.
Correct Answer: A
Rationale: The correct answer is A. When starting on hormone replacement therapy (HRT), the nurse should discuss the increased risks of cardiovascular events and breast cancer with the patient. These risks are important to consider to make an informed decision. Choice B is incorrect as HRT does not increase the risk of osteoporosis; in fact, it may help prevent it. Choice C is incorrect as while HRT can increase the risk of venous thromboembolism, regular screening is not the primary focus for discussion. Choice D is incorrect as HRT does not decrease the risk of fractures and is not primarily associated with an increased risk of developing diabetes.
A client has been admitted to the hospital with symptoms of Guillain-Barr© syndrome. Which aspect of the client's condition would require priority monitoring?
- A. Monitoring oxygen saturation levels
- B. Monitoring for signs of respiratory compromise
- C. Monitoring for changes in consciousness
- D. Monitoring blood pressure closely
Correct Answer: B
Rationale: In Guillain-Barr© syndrome, respiratory muscle weakness can lead to respiratory compromise, making it crucial to prioritize monitoring for signs of respiratory distress. Monitoring oxygen saturation levels is important but is secondary to assessing for respiratory compromise in this condition. Changes in consciousness and monitoring blood pressure closely are not typically the priority in Guillain-Barr© syndrome.
A patient's current medical condition is suggestive of impaired erythropoiesis. Which of the following laboratory studies would be most clinically relevant in diagnosing this health problem?
- A. White blood cell count with differential
- B. RBC, hemoglobin, and hematocrit
- C. INR and aPTT
- D. d-dimer and C-reactive protein
Correct Answer: B
Rationale: In this scenario, where impaired erythropoiesis is suspected, the most clinically relevant laboratory studies would focus on red blood cell parameters. Therefore, assessing RBC count, hemoglobin levels, and hematocrit values would provide direct insights into erythropoiesis. Choices A, C, and D are not directly related to erythropoiesis assessment. White blood cell count with a differential is more indicative of immune response and infection. INR and aPTT are coagulation studies, while d-dimer and C-reactive protein levels are more associated with inflammation and thrombotic events.