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In neuroblastoma, metastatic spread can occur via local invasion or distant hematogenous/lymphatic routes. The LEAST common site of metastases in neuroblastoma is
- A. long bone
- B. bone marrow
- C. lung
- D. skin
Correct Answer: D
Rationale: Skin metastases are rare in neuroblastoma compared to bone, bone marrow, and lung involvement.
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A client seeks medical evaluation for fatigue, night sweats, and a 20-lb weight loss in 6 weeks. To confirm that the client has been infected with the human immunodeficiency virus (HIV), the nurse expects the physician to order:
- A. E-rosette immunofluorescence
- B. Enzyme-linked immunosorbent assay
- C. Quantification of T-lymphocytes (ELISA)
- D. Western blot test with ELISA
Correct Answer: D
Rationale: The confirmatory test for HIV infection is a Western blot test. However, before a Western blot test is conducted, an initial screening test with high sensitivity, such as the enzyme-linked immunosorbent assay (ELISA), is typically performed. ELISA is used to detect the presence of HIV antibodies in the blood. If the ELISA test is positive, a Western blot test is then performed to confirm the presence of specific HIV antibodies. The Western blot test is a more specific test for HIV antibodies and is used to confirm the diagnosis. Therefore, in this case, the physician would most likely order a Western blot test following a positive ELISA test to confirm the client's HIV infection.
Which statement regarding chlamydia infection is correct?
- A. Treatment of choice is oral penicillin.
- B. Treatment of choice is nystatin or miconazole.
- C. Clinical manifestations include dysuria and urethral itching in males.
- D. Clinical manifestations include small, painful vesicles on genital areas.
Correct Answer: C
Rationale: The correct statement regarding chlamydia infection is that the clinical manifestations include dysuria and urethral itching in males. Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. In males, common symptoms include a burning sensation during urination (dysuria) and urethral itching. It is important to note that chlamydia is often asymptomatic, especially in women, which is why regular screening is important to detect and treat the infection early. Option A is incorrect because the treatment of choice for chlamydia is typically antibiotics such as azithromycin or doxycycline, not oral penicillin. Option B is incorrect because nystatin or miconazole are used to treat fungal infections, not chlamydia. Option D is incorrect because small, painful vesicles on genital areas are more indicative of herpes simplex virus infection rather than chlamydia
Herpes zoster is caused by the varicella virus and has an affinity for:
- A. sympathetic nerve fibers.
- B. parasympathetic nerve fibers.
- C. posterior root ganglia and posterior horn of the spinal cord.
- D. lateral and dorsal columns of the spinal cord.
Correct Answer: C
Rationale: Herpes zoster, commonly known as shingles, is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. This virus has an affinity for sensory nerve fibers, particularly those located in the posterior root ganglia and the posterior horn of the spinal cord. When the virus becomes reactivated, it travels along these nerves to the skin, leading to the characteristic painful rash and blisters that are seen in herpes zoster. The involvement of these specific nerve fibers explains the typical dermatomal distribution of the rash in shingles.
A patient is unable to control his bowels ff. a subarachnoid hemorrhage. Which intervention by the nurse can help reduce episodes of bowel incontinence?
- A. Ask the patient frequently if he has to have a bowel movement
- B. Place incontinence pads on the patient's bed and chair
- C. Toilet the patient according to his pre-illness schedule, whether or not he feels the urge
- D. Take care not to embarrass the patient when incontinent episode occur
Correct Answer: C
Rationale: Option C, which is to toilet the patient according to his pre-illness schedule, whether or not he feels the urge, is the best intervention by the nurse to help reduce episodes of bowel incontinence in this patient with subarachnoid hemorrhage. This strategy can help establish a routine and promote regular bowel movements, which may reduce the likelihood of bowel incontinence episodes. Asking the patient frequently if he has to have a bowel movement (Option A) may not be effective, as the patient may not always be able to accurately communicate their needs due to the underlying condition. Placing incontinence pads on the patient's bed and chair (Option B) may manage the consequences of incontinence but does not address the root cause. While taking care not to embarrass the patient when incontinent episodes occur (Option D) is important for maintaining the patient's dignity, it does not directly address the issue of reducing bowel incontinence episodes.
A 1-year old boy presents with high grade fever and conjunctivitis for 4 days followed by generalized maculopapular rash. One of his elder siblings had similar complaints 10 days back. The most likely diagnosis is?
- A. Rubella
- B. Kawasaki disease
- C. Scarlet fever
- D. Measles
Correct Answer: D
Rationale: Measles presents with high-grade fever, conjunctivitis, and a maculopapular rash appearing after a few days of illness, often following a similar illness in a sibling.