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A patient presents with sudden-onset, painless vision loss in the right eye. Fundoscopic examination reveals a cherry-red spot at the macula and attenuated retinal vessels. Which of the following conditions is most likely responsible for this presentation?
- A. Central retinal artery occlusion
- B. Central retinal vein occlusion
- C. Retinal detachment
- D. Acute angle-closure glaucoma
Correct Answer: A
Rationale: The patient's presentation of sudden-onset, painless vision loss in the right eye, along with a cherry-red spot at the macula and attenuated retinal vessels, is classic for central retinal artery occlusion (CRAO). In CRAO, there is a sudden blockage of the central retinal artery, leading to ischemia of the retina. The cherry-red spot represents the preserved choroid blood flow against the ischemic retina. The attenuated retinal vessels are a result of decreased blood flow in the retinal circulation. This condition is considered an ophthalmic emergency and requires immediate evaluation and management to prevent permanent vision loss.
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A nurse is caring for a patient who refuses to comply with a prescribed treatment regimen. What ethical principle should guide the nurse's approach to addressing the patient's refusal?
- A. Beneficence
- B. Autonomy
- C. Nonmaleficence
- D. Justice
Correct Answer: B
Rationale: The ethical principle of autonomy emphasizes respecting the patient's right to make their own decisions regarding their treatment. In this scenario, the patient has the right to refuse treatment, and the nurse should respect that decision while also providing information and guidance to help the patient make informed choices. By upholding the principle of autonomy, the nurse can support the patient's decision-making process and work collaboratively with them to address any concerns or barriers to compliance with the treatment regimen. This approach honors the patient's right to self-determination and promotes a trusting relationship between the nurse and the patient.
A patient with systemic lupus erythematosus (SLE) demonstrates a positive antinuclear antibody (ANA) test and elevated levels of anti-double-stranded DNA (anti-dsDNA) antibodies. Which of the following mechanisms is most likely responsible for the production of these autoantibodies?
- A. Loss of self-tolerance
- B. Failure of innate immunity
- C. Defective T cell activation
- D. Impaired phagocytosis
Correct Answer: A
Rationale: The development of autoantibodies such as antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies in systemic lupus erythematosus (SLE) is primarily attributed to a loss of self-tolerance. Self-tolerance refers to the immune system's ability to recognize and differentiate self-antigens from foreign antigens. In individuals with SLE, there is a breakdown in immune tolerance mechanisms, leading to the production of autoantibodies against self-antigens like nuclear components (e.g., DNA, RNA, histones). This loss of self-tolerance results in the immune system targeting and attacking its tissues, leading to the systemic inflammation and tissue damage characteristic of SLE. The presence of elevated levels of ANA and anti-dsDNA antibodies in this patient suggests an autoimmune response against nuclear material, further supporting the role of self-tolerance breakdown in SLE
A postpartum client expresses concerns about breastfeeding and worries about inadequate milk supply. What nursing intervention should be prioritized to address the client's concerns?
- A. Assessing the infant's latch and feeding effectiveness
- B. Recommending supplemental formula feedings to ensure adequate nutrition
- C. Educating the client about techniques to increase milk production
- D. Referring the client to a lactation consultant for assistance
Correct Answer: A
Rationale: Assessing the infant's latch and feeding effectiveness should be prioritized as the initial nursing intervention to address the client's concerns about inadequate milk supply. Poor latch can lead to ineffective milk removal, which may result in decreased milk production. By ensuring the infant is latching correctly and effectively transferring milk, the client's milk supply can be optimized. Education about techniques to increase milk production can be provided following the assessment of feeding effectiveness. Referring to a lactation consultant may be necessary for further evaluation and support if issues persist despite correcting the latch. Supplemental formula feedings should be recommended as a last resort after all other interventions have been attempted and if there are concerns about inadequate nutrition for the infant.
A patient with chronic kidney disease presents with progressively worsening anemia and elevated serum phosphate levels. Which medication is commonly prescribed to reduce serum phosphate levels in patients with chronic kidney disease?
- A. Epoetin alfa
- B. Cinacalcet
- C. Sevelamer
- D. Allopurinol
Correct Answer: C
Rationale: Sevelamer is a medication commonly prescribed to reduce serum phosphate levels in patients with chronic kidney disease. Sevelamer is a phosphate binder that works by binding to dietary phosphate in the gut, preventing its absorption into the bloodstream. By reducing serum phosphate levels, sevelamer helps manage complications associated with hyperphosphatemia in chronic kidney disease patients, such as mineral and bone disorders. Other medications like epoetin alfa are used to treat anemia commonly seen in chronic kidney disease patients, while cinacalcet is used to manage secondary hyperparathyroidism. Allopurinol, on the other hand, is used to treat gout by reducing uric acid levels and is not indicated for reducing serum phosphate levels in chronic kidney disease patients.
A patient presents with a thyroid nodule and signs of compression such as difficulty swallowing and breathing. Fine-needle aspiration biopsy reveals malignant cells with nuclear features suggestive of papillary thyroid carcinoma. Which endocrine disorder is most likely responsible for these symptoms?
- A. Hashimoto's thyroiditis
- B. Graves' disease
- C. Diabetes mellitus
- D. Papillary thyroid carcinoma
Correct Answer: D
Rationale: Papillary thyroid carcinoma is a type of thyroid cancer that arises from follicular cells of the thyroid gland. It often presents as a thyroid nodule that can cause symptoms of compression due to its enlarging size. The compression symptoms, such as difficulty swallowing and breathing in this case, occur when the thyroid nodule becomes large enough to press on adjacent structures in the neck. Fine-needle aspiration biopsy can confirm the presence of malignant cells with nuclear features typical of papillary thyroid carcinoma, further supporting the diagnosis.