Nokea
A 30 year old patient had presented with fever and posterior cervical lymphadenopathy over the past two years. Which is the most probably causative organism?
- A. Trypanosoma cruzi
- B. Trypanosoma brucei rhodesiense
- C. Trypanosoma brucei gambiense
- D. Leishmania donovani
Correct Answer: C
Rationale: The correct answer is C: Trypanosoma brucei gambiense. This is the most probable causative organism because the patient's presentation of fever and posterior cervical lymphadenopathy over a prolonged period aligns with the chronic infection caused by Trypanosoma brucei gambiense, which leads to African Trypanosomiasis (sleeping sickness). Trypanosoma cruzi (choice A) causes Chagas disease, which typically presents with acute symptoms such as fever and swelling at the site of infection. Trypanosoma brucei rhodesiense (choice B) causes acute African Trypanosomiasis with a more rapid progression compared to gambiense. Leishmania donovani (choice D) causes visceral leishmaniasis, which presents with prolonged fever, splenomegaly, and pancytopenia, but not typically with cervical lymphadenopathy.
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You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
- A. Pleuropulmonary blastoma
- B. Hepatocellular carcinoma
- C. Cystic nephroma
- D. Nephroblastoma
Correct Answer: D
Rationale: Step-by-step rationale for why the correct answer is D, Nephroblastoma:
1. The child has a cancer predisposition syndrome, likely Beckwith-Wiedemann syndrome (BWS).
2. BWS is associated with an increased risk of developing Wilms tumor (nephroblastoma).
3. The large tongue, omphalocele, and overgrowth placing the child at the 95th percentile for height and weight are all characteristic features of BWS.
4. Therefore, the patient is most at risk of developing nephroblastoma.
Summary of why the other choices are incorrect:
A: Pleuropulmonary blastoma - Not typically associated with BWS or the described clinical features.
B: Hepatocellular carcinoma - Not commonly linked to BWS or the clinical presentation provided.
C: Cystic nephroma - Not a typical tumor associated with BWS or the clinical findings described in the patient.
A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?
- A. Activating thromboxane A2
- B. Blocking adenosine diphosphate receptor agonists
- C. Suppressing specific clotting factors
- D. Inhibiting cyclooxygenase action in platelets
Correct Answer: D
Rationale: The correct answer is D: Inhibiting cyclooxygenase action in platelets. Aspirin inhibits cyclooxygenase, specifically COX-1, in platelets, leading to the inhibition of thromboxane A2 production. Thromboxane A2 is a potent platelet aggregator. By inhibiting its production, aspirin reduces platelet aggregation, thus reducing the risk of cardiovascular events.
A: Activating thromboxane A2 - This is incorrect because aspirin actually inhibits the production of thromboxane A2.
B: Blocking adenosine diphosphate receptor agonists - This is incorrect because aspirin primarily works through the inhibition of cyclooxygenase, not adenosine diphosphate receptors.
C: Suppressing specific clotting factors - This is incorrect because aspirin's primary mechanism of action is through platelet inhibition, not through suppressing clotting factors.
In a study to investigate the rates of central line–acquired bacterial infections, it is discovered that patient length of stay (LOS) is not normally distributed but is highly right-skewed. What is the correct relationship between the mean, median, and mode of LOS?
- A. The mean is less than the median but greater than the mode.
- B. The mean is equal to the median and the mode.
- C. The mean is greater than the median and mode.
- D. The mean and median will both be less than the mode.
Correct Answer: C
Rationale: The correct relationship between mean, median, and mode in a highly right-skewed distribution is that the mean is greater than the median and mode. In a right-skewed distribution, the mean is pulled towards the longer tail, making it greater than the median, which is the middle value when the data is arranged in order. The mode is the most frequent value, but in a right-skewed distribution, it will be the smallest value, making the mean greater than both the median and mode. Therefore, choice C is correct. Choices A, B, and D are incorrect because they do not reflect the specific relationship between mean, median, and mode in a highly right-skewed distribution.
The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?
- A. Plasma
- B. Platelets
- C. Red blood cells
- D. White blood cells
Correct Answer: B
Rationale: Platelets are responsible for clot formation in the body. When a wound occurs, platelets adhere to the site and release chemicals to initiate clotting. They then aggregate to form a plug, stopping bleeding. Plasma carries platelets but is not directly involved in clot formation. Red blood cells transport oxygen but do not participate in clotting. White blood cells are part of the immune system and do not play a role in clot formation. Therefore, platelets are the correct choice for clot formation in this scenario.
A nurse is assessing a dark-skinned client for pallor. What action is best?
- A. Assess the conjunctiva of the eye.
- B. Have the client open the hand widely.
- C. Look at the roof of the client's mouth.
- D. Palpate for areas of mild swelling.
Correct Answer: A
Rationale: The correct answer is A: Assess the conjunctiva of the eye. This is because pallor, which is paleness of the skin, can be difficult to detect on dark skin. The conjunctiva of the eye is a mucous membrane that is not pigmented and can provide a more accurate indication of pallor. Options B, C, and D are not ideal for assessing pallor in a dark-skinned client as they may not show paleness accurately. B is more related to checking for pallor in fair-skinned individuals. C and D are not reliable indicators of pallor in any skin type.