Nokea
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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Rhabdomyolysis can result in serious complications. In addition to muscle pain and weakness, a patient will complain of:
- A. paresthesias.
- B. bone pain.
- C. dark urine.
- D. diarrhea.
Correct Answer: C
Rationale: Dark urine is a classic symptom of rhabdomyolysis. When muscle breakdown occurs, myoglobin is released into the bloodstream and filtered by the kidneys, leading to dark urine. Paresthesias (choice A) refer to abnormal sensations like tingling or numbness and are not typically associated with rhabdomyolysis. Bone pain (choice B) is not a prominent symptom of rhabdomyolysis. Diarrhea (choice D) is not a common complaint in rhabdomyolysis cases and is not directly related to muscle breakdown.
A woman is complaining that she feels like the room is spinning even though she is not moving. Which of the following is characteristic of benign positional vertigo?
- A. It usually occurs with a headache.
- B. Pupillary changes are common.
- C. It is usually triggered when the patient bends forward.
- D. Nystagmus continues even when the eyes fixate on an object.
Correct Answer: C
Rationale: The correct answer is C: 'It is usually triggered when the patient bends forward.' Benign positional vertigo is often triggered by changes in head position, such as bending forward. Choices A, B, and D are incorrect. A is incorrect because benign positional vertigo is not typically associated with headaches. B is incorrect because pupillary changes are not a common feature of benign positional vertigo. D is incorrect because nystagmus in benign positional vertigo usually stops when the eyes fixate on an object.
A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?
- A. Decreased interest in activities that she once enjoyed
- B. Fear of being alone at night
- C. Increased complaints of physical ailments
- D. Problems with preparing a meal or balancing her checkbook
Correct Answer: D
Rationale: The correct answer is D. Problems with tasks like meal preparation and balancing a checkbook can indicate cognitive impairment, as these activities involve cognitive functions such as memory, attention, and executive function. Choices A, B, and C are less indicative of cognitive impairment. Decreased interest in activities and increased complaints of physical ailments may be related to other factors like depression, while fear of being alone at night could be due to anxiety or other psychological issues.
In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:
- A. Aphasia.
- B. Agnosia.
- C. Sundowning.
- D. Confabulation.
Correct Answer: C
Rationale: The correct answer is C: Sundowning. Sundowning is a phenomenon where individuals with cognitive impairment experience increased confusion and agitation in the late afternoon or early evening. This often occurs in conditions like dementia. Choice A, Aphasia, refers to a language disorder affecting a person's ability to communicate. Choice B, Agnosia, is the inability to recognize objects. Choice D, Confabulation, is the production of false memories without the intention to deceive, often seen in conditions like Korsakoff's syndrome.
Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is, what the date, month, and year are, and where the client is. The nurse is attempting to assess:
- A. confabulation.
- B. delirium.
- C. orientation.
- D. perseveration.
Correct Answer: C
Rationale: The correct answer is C: "orientation." Nurse Isabelle is assessing the client's orientation by asking questions about time (day, date, month, year), place, and person. This assessment helps determine the client's awareness of their surroundings and situation. Confabulation (choice A) is the unintentional fabrication of details or events to fill in memory gaps and is not being assessed in this scenario. Delirium (choice B) is a state of acute confusion and disorientation, usually with a rapid onset, which is different from assessing orientation. Perseveration (choice D) refers to the persistent repetition of a response, statement, or behavior and is not the focus of the assessment being conducted by Nurse Isabelle in this situation.