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A patient presents with sudden-onset severe headache, vomiting, and altered mental status. Imaging reveals a berry-shaped aneurysm at the junction of the anterior communicating artery and anterior cerebral artery. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Ischemic stroke
- B. Intracerebral hemorrhage
- C. Subdural hematoma
- D. Subarachnoid hemorrhage
Correct Answer: D
Rationale: The presentation of sudden-onset severe headache, vomiting, and altered mental status, along with the presence of a berry-shaped aneurysm on imaging, point towards a diagnosis of subarachnoid hemorrhage. The most common cause of a subarachnoid hemorrhage is the rupture of a saccular (berry) aneurysm, which commonly occurs at the junction of the anterior communicating artery and anterior cerebral artery. The sudden headache is often described as the "worst headache of my life" and is typically associated with nausea and vomiting. Altered mental status may be present due to the effects of increased intracranial pressure and possible associated brain injury. It is important to promptly diagnose and manage subarachnoid hemorrhage to prevent complications such as vasospasm, rebleeding, and ischemic deficits.
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A patient presents with fatigue, pallor, and dyspnea on exertion. Laboratory tests reveal a low hemoglobin level, decreased mean corpuscular volume (MCV), and decreased mean corpuscular hemoglobin concentration (MCHC). Which of the following conditions is most likely to cause these findings?
- A. Iron deficiency anemia
- B. Vitamin B12 deficiency anemia
- C. Thalassemia
- D. Sickle cell anemia
Correct Answer: A
Rationale: The patient's presentation with fatigue, pallor, dyspnea on exertion, low hemoglobin level, decreased MCV, and decreased MCHC are all consistent with iron deficiency anemia. Iron deficiency anemia is the most common type of anemia and occurs when there is insufficient iron available for hemoglobin production. The low hemoglobin level results in symptoms such as fatigue and pallor, while the decreased MCV and MCHC indicate microcytic and hypochromic red blood cells, respectively, which are characteristic of iron deficiency anemia. Vitamin B12 deficiency anemia and thalassemia typically present with a different pattern of laboratory findings and clinical manifestations. Sickle cell anemia is characterized by sickle-shaped red blood cells due to a genetic mutation, and the laboratory findings in sickle cell anemia are different from those seen in the patient described in this scenario.
The nurse knows that a dog bite has a shorter incubation for rabies if located in the
- A. Leg
- B. abdomen
- C. hand
- D. face
Correct Answer: C
Rationale: Rabies has a shorter incubation period if the bite is located on the hand. This is because bites on the hand are more likely to have direct access to nerve pathways, which can lead to a faster spread of the rabies virus to the central nervous system. In general, bites on parts of the body closer to the brain and spinal cord, such as the hand and face, can result in a quicker onset of rabies symptoms compared to bites on farther extremities like the leg or abdomen.
Autonomy is the prerogative of the patient to give consent or refusal of treatment with the EXCEPTION of which of the following situations?
- A. Erroneous belief of a head of a church
- B. Negative effect of superstition
- C. Near death
- D. Peer pressure
Correct Answer: A
Rationale: Autonomy refers to the patient's right to make decisions about their own health care, including the ability to give consent or refusal of treatment. This right is based on the patient's own beliefs, values, and preferences. However, in the case of an erroneous belief of a head of a church, it may conflict with the patient's own autonomy and ability to make decisions based on their own beliefs. In such a situation, it is important for healthcare providers to respect the patient's autonomy while also addressing any potential conflicts that may arise from external influences such as the erroneous belief of a head of a church.
A nurse is preparing to assist with a transesophageal echocardiogram (TEE) procedure for a patient. What action should the nurse prioritize to ensure patient safety during TEE?
- A. Placing the patient in a supine position with arms at their sides
- B. Administering intravenous sedation to the patient before the procedure
- C. Instructing the patient to refrain from eating or drinking for six hours before the procedure
- D. Ensuring the availability of emergency equipment and resuscitation medications
Correct Answer: D
Rationale: Ensuring the availability of emergency equipment and resuscitation medications is crucial to prioritize patient safety during a transesophageal echocardiogram (TEE) procedure. TEE involves inserting a specialized probe (transducer) into the esophagus to obtain detailed images of the heart. While complications during TEE are rare, they can include adverse reactions to sedation, esophageal injury, arrhythmias, or other cardiac events. By having emergency equipment and resuscitation medications readily available, the healthcare team can respond promptly to any unforeseen complications or emergencies that may arise during the procedure, ensuring optimal patient safety. Placing the patient in a supine position, providing sedation, and advising the patient to fast before the procedure are important aspects of the TEE process; however, ensuring emergency preparedness takes precedence in prioritizing patient safety during the procedure.
A patient presents with progressive weakness, muscle atrophy, and fasciculations, primarily involving the upper and lower extremities. Over time, the patient develops difficulty swallowing and breathing. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Parkinson's disease
- B. Guillain-Barré syndrome (GBS)
- C. Amyotrophic lateral sclerosis (ALS)
- D. Myasthenia gravis
Correct Answer: C
Rationale: The symptoms described are classic for amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, leading to muscle weakness and atrophy. Patients typically present with weakness, muscle atrophy, fasciculations (muscle twitching), and eventually develop difficulty swallowing and breathing due to involvement of the muscles responsible for these functions. Parkinson's disease (Choice A) is a neurodegenerative disorder characterized by tremors, rigidity, and bradykinesia but does not typically present with muscle atrophy or fasciculations as described in the case. Guillain-Barré syndrome (GBS) (Choice B) is an acute inflammatory condition affecting peripheral nerves, leading to ascending paralysis, which is usually reversible. Myasthenia gravis (Choice D) is an autoimmune disorder that affects neu