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A patient presents with decreased hearing related to antibiotic use. Which class of antibiotics is this?
- A. Aminoglycosides
- B. Beta-lactams
- C. Cephalosporins
- D. Macrolides
Correct Answer: A
Rationale: The correct answer is A: Aminoglycosides. Aminoglycosides can cause ototoxicity, resulting in decreased hearing. They are known to damage the sensory cells in the inner ear. Beta-lactams (B) and Cephalosporins (C) are not associated with hearing loss. Macrolides (D) can rarely cause hearing loss but are not as commonly linked to ototoxicity as aminoglycosides.
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Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman?
- A. Hirsutism
- B. Gynecomastia
- C. Oligomenorrhea
- D. Acne
Correct Answer: D
Rationale: Rationale for correct answer D: Acne is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman because hyperprolactinemia usually presents with symptoms related to hormonal imbalance, such as irregular menstrual cycles (oligomenorrhea), breast changes (gynecomastia), and excess body hair (hirsutism). Acne is not directly associated with elevated prolactin levels.
Summary of incorrect choices:
A: Hirsutism - Hirsutism is a common finding in hyperprolactinemia due to hormonal imbalances.
B: Gynecomastia - Gynecomastia can occur in hyperprolactinemia due to the suppression of testosterone.
C: Oligomenorrhea - Oligomenorrhea is a typical finding in hyperprolactinemia due to disruptions in the menstrual cycle.
You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem?
- A. Optic nerve damage on the right
- B. Optic nerve damage on the left
- C. Efferent nerve damage on the right
- D. Efferent nerve damage on the left
Correct Answer: C
Rationale: The correct answer is C: Efferent nerve damage on the right. When both pupils dilate but only the right pupil constricts briskly in response to light, it indicates a problem with the efferent pathway controlling the right eye's pupillary constriction. This suggests damage to the parasympathetic fibers of the oculomotor nerve (CN III) that innervate the pupillary sphincter muscle. Choices A and B (optic nerve damage) do not involve pupil constriction. Choice D (efferent nerve damage on the left) would not explain the brisk constriction in the right eye.
A 40-year-old female, the overall texture of the breast is soft, with an uneven contour bilaterally. The NP informs the patient that:
- A. Warrants a mammogram
- B. Is considered normal
- C. May be suggestive of fibroadenoma
- D. May indicate cystic breast
Correct Answer: B
Rationale: Step-by-step rationale:
1. The patient is 40 years old, which is within the age range for routine screening mammograms.
2. The description of soft, uneven breasts is typical of normal breast tissue variations.
3. Given the patient's age and the benign characteristics described, no further investigation is needed.
Summary of other choices:
A: Warrants a mammogram - Not necessary as the breast characteristics described are normal for the patient's age.
C: May be suggestive of fibroadenoma - Fibroadenomas typically present as firm, well-defined lumps, not soft and uneven breasts.
D: May indicate cystic breast - Cystic breasts may feel lumpy or tender, but the overall texture is not described as soft and uneven.
Where should the uterine fundus be palpable at 12 weeks?
- A. At the level of the umbilicus
- B. At the level of the symphysis pubis
- C. Midway between the symphysis and umbilicus
- D. Below the symphysis pubis
Correct Answer: B
Rationale: At 12 weeks of gestation, the uterine fundus should be palpable at the level of the symphysis pubis. This is because the uterus rises approximately 1 cm above the symphysis pubis each week during the first trimester. By 12 weeks, it should be palpable at this level.
Choice A (At the level of the umbilicus) is incorrect because the fundus is not expected to reach the level of the umbilicus until around 20 weeks.
Choice C (Midway between the symphysis and umbilicus) is incorrect as this would typically occur around 16-18 weeks.
Choice D (Below the symphysis pubis) is also incorrect because by 12 weeks, the fundus should have risen above the symphysis pubis.
The nurse is caring for a client with dementia. Which intervention is most likely to reduce agitation in this client?
- A. Provide a calm environment with minimal stimulation.
- B. Increase social activities to promote interaction.
- C. Encourage frequent visitors to engage with the client.
- D. Provide a variety of activities to keep the client busy.
Correct Answer: A
Rationale: The correct answer is A: Provide a calm environment with minimal stimulation. This intervention is most likely to reduce agitation in a client with dementia because excessive stimulation can overwhelm and confuse them, leading to increased agitation. By creating a calm environment with minimal stimuli, the client can feel more relaxed and less agitated.
Summary:
B: Increasing social activities may actually worsen agitation as it can be overwhelming for a client with dementia.
C: While social engagement is important, too many visitors can increase agitation.
D: Providing a variety of activities may lead to confusion and frustration instead of reducing agitation.