Nokea
A patient presents with recurrent episodes of brief, severe, stabbing pain in the distribution of the trigeminal nerve. Episodes are triggered by touch, chewing, or cold exposure. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Migraine headache
- B. Cluster headache
- C. Tension-type headache
- D. Trigeminal neuralgia
Correct Answer: D
Rationale: The correct answer is D: Trigeminal neuralgia. This condition is characterized by recurrent, severe, stabbing pain in the trigeminal nerve distribution triggered by touch, chewing, or cold exposure. The key feature is the characteristic lancinating pain, which is not typical of migraine (choice A), cluster headache (choice B), or tension-type headache (choice C). Migraine typically presents with pulsating, moderate to severe headache associated with nausea and sensitivity to light and sound. Cluster headache is characterized by severe, unilateral pain around the eye associated with autonomic symptoms. Tension-type headache presents with bilateral, pressing or tightening pain without specific triggers. Therefore, based on the description of the symptoms in the question, trigeminal neuralgia is the most likely diagnosis.
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Which of the following is the PRIMARY reason for surgical repair of myelomeningocele? To ____________.
- A. Decrease risk of infection
- B. Correct the neurologic defect
- C. Prevent seizure disorders
- D. Prevent hydrocephalus
Correct Answer: B
Rationale: The primary reason for surgical repair of myelomeningocele is to correct the neurologic defect. This is because myelomeningocele is a type of neural tube defect where the spinal cord and its protective covering do not close properly. Surgical repair aims to close the opening in the spinal cord to prevent further damage, improve neurological function, and reduce the risk of complications such as paralysis and infection. The other choices are incorrect as they are not the primary goal of the surgery. Preventing infection (Choice A) is important but not the primary reason. Seizure disorders (Choice C) and hydrocephalus (Choice D) may be associated complications but are not the main purpose of the surgical repair.
For the past 6 months, several nurses are resigning. Some have verbalized in the exit interview that there are not happy anymore. Which of the following descriptions manifest BEST, a nurse who has job satisfaction?
- A. Competitive, self-centered, euphoric.
- B. Empowered, enthusiastic, ethical.
- C. Loner, egoistic, reactive.
- D. Outgoing, sensitive, competitive.
Correct Answer: B
Rationale: The correct answer is B because an empowered nurse feels in control and valued, leading to job satisfaction. Enthusiasm shows motivation and engagement with their work. Being ethical indicates a commitment to moral principles, contributing to a sense of fulfillment.
Choice A is incorrect as competitiveness and self-centeredness do not necessarily equate to job satisfaction. Euphoria may not be a sustainable indicator of satisfaction.
Choice C is incorrect because being a loner and egoistic are not traits associated with job satisfaction. Reactivity may suggest a lack of control or frustration.
Choice D is incorrect as being outgoing and competitive might not directly translate to job satisfaction. Sensitivity alone does not guarantee satisfaction in the workplace.
A pregnant woman presents with fever, chills, and abdominal pain localized to the right upper quadrant. On examination, she has tenderness in the right upper abdomen and a positive Murphy's sign. Which of the following conditions is the most likely cause of these symptoms?
- A. Ectopic pregnancy
- B. Pelvic inflammatory disease
- C. Acute cholecystitis
- D. Ovarian torsion
Correct Answer: C
Rationale: The scenario described in the question is consistent with acute cholecystitis, which is inflammation of the gallbladder usually caused by an impacted gallstone in the cystic duct. The key clinical features of acute cholecystitis include fever, chills, right upper quadrant abdominal pain (which can be localized to the right upper quadrant), tenderness in the right upper abdomen, and a positive Murphy's sign (pain and inspiratory arrest upon palpation of the right upper quadrant). This condition is more common in pregnant women due to hormonal changes that can lead to gallstone formation and subsequent inflammation of the gallbladder. Ectopic pregnancy, pelvic inflammatory disease, and ovarian torsion typically present with different clinical features compared to those described in acute cholecystitis.
A patient presents with chronic nasal congestion, hyposmia, and anosmia. Nasal endoscopy reveals polypoid masses obstructing the nasal cavity and sinuses. Which of the following conditions is most likely responsible for this presentation?
- A. Allergic rhinitis
- B. Chronic sinusitis
- C. Nasal polyps
- D. Deviated nasal septum
Correct Answer: C
Rationale: The correct answer is C: Nasal polyps. Nasal polyps are benign growths that form in the nasal cavity and sinuses, leading to symptoms such as chronic nasal congestion, hyposmia, and anosmia. The presence of polypoid masses seen on nasal endoscopy is characteristic of nasal polyps.
Rationale:
1. Chronic nasal congestion, hyposmia, and anosmia are common symptoms of nasal polyps.
2. Nasal endoscopy revealing polypoid masses confirms the presence of nasal polyps.
3. Allergic rhinitis may cause nasal congestion but does not typically present with polypoid masses.
4. Chronic sinusitis can cause nasal congestion but is usually associated with inflammation of the sinuses, not just polypoid masses.
5. A deviated nasal septum can lead to nasal congestion but does not typically cause polypoid masses obstructing the nasal cavity and sinuses.
A patient receiving palliative care for end-stage cancer experiences intractable pain despite receiving opioid medications. What intervention should the palliative nurse prioritize to address the patient's pain?
- A. Increase the dosage of the current opioid medication.
- B. Switch to a different opioid medication with a different potency.
- C. Administer adjuvant analgesic medications to enhance pain relief.
- D. Refer the patient to a pain management specialist for evaluation.
Correct Answer: D
Rationale: The correct answer is D because referring the patient to a pain management specialist for evaluation is essential in this scenario. The specialist can conduct a comprehensive assessment to identify the underlying causes of the intractable pain and recommend a tailored pain management plan. This approach ensures a multidisciplinary approach to address the complex nature of the patient's pain.
Choice A is incorrect because simply increasing the dosage of the current opioid medication may not effectively address the underlying cause of the pain and can lead to potential side effects or opioid tolerance.
Choice B is incorrect as switching to a different opioid medication without a thorough evaluation may not guarantee better pain control and can increase the risk of adverse effects or inadequate pain relief.
Choice C is incorrect as administering adjuvant analgesic medications without addressing the root cause of the pain may not provide adequate pain relief and does not address the need for a specialized pain management plan.