Nokea
Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur?
- A. The only treatment modalities for the disease are palliative.
- B. Diagnostic tests are not available to detect tumors before they metastasize.
- C. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
- D. Early metastasis to the brain impairs the patient’s ability to recognize the seriousness of symptoms.
Correct Answer: D
Rationale: The correct answer is D because early metastasis to the brain can impair the patient's ability to recognize the seriousness of symptoms. This can delay diagnosis and treatment, leading to a higher percentage of patients having metastasis at the time of diagnosis.
A is incorrect because there are treatment modalities for kidney cancer beyond palliative care. B is incorrect as diagnostic tests like imaging studies can detect tumors before they metastasize. C is incorrect because while classic symptoms may not always be present, other symptoms and diagnostic tests can still lead to an earlier diagnosis.
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A 30-year-old woman presents to the clinic with a complaint of a delayed period and abdominal discomfort. The nurse suspects pregnancy. Which of the following is the earliest and most reliable sign of pregnancy?
- A. A missed period.
- B. Positive urine pregnancy test.
- C. Changes in breast size.
- D. Abdominal tenderness and bloating.
Correct Answer: C
Rationale: The correct answer is C: Changes in breast size. This is because hormonal changes in early pregnancy can cause breast tenderness, swelling, and darkening of the areola. This typically occurs before a missed period or a positive urine pregnancy test. A missed period (choice A) is a common sign of pregnancy, but not the earliest. A positive urine pregnancy test (choice B) confirms pregnancy but may not be the earliest sign. Abdominal tenderness and bloating (choice D) can occur due to various reasons and are not specific to pregnancy. Therefore, changes in breast size are the earliest and most reliable sign of pregnancy in this scenario.
Clients who have had a ureterolithotomy should be taught to expect
- A. a great deal of postoperative pain
- B. postoperative depression
- C. enforced bed rest for a week postoperatively
- D. large amounts of drainage from the tissue drain
Correct Answer: D
Rationale: The correct answer is D because after a ureterolithotomy, there may be drainage from the tissue drain, which is a normal occurrence. This drainage helps to prevent complications such as infection and promotes healing. The drainage should decrease over time as the body heals. Choices A, B, and C are incorrect as they do not align with the typical expectations following a ureterolithotomy procedure. Postoperative pain should be managed with medication, postoperative depression may occur but is not a universal expectation, and enforced bed rest for a week is not typically necessary.
Which of the following cephalosporins has activity against gram negative anaerobic bacteria like Bacteroides fragilis, and the only cephalosporins that cross the blood brain barrier and enter the brain?
- A. Ceftriaxone
- B. Cefoxitin
- C. Cephalexin
- D. Cefixime
Correct Answer: A
Rationale: Rationale:
1. Ceftriaxone is a third-generation cephalosporin known for broad-spectrum coverage.
2. It has excellent activity against gram-negative anaerobes such as Bacteroides fragilis.
3. It is also one of the cephalosporins that can penetrate the blood-brain barrier.
4. The other choices do not have the same anaerobic coverage or BBB penetration.
Summary:
- B: Cefoxitin is a second-generation cephalosporin with anaerobic coverage but does not cross the BBB.
- C: Cephalexin is a first-generation cephalosporin with limited anaerobic activity and no BBB penetration.
- D: Cefixime is a third-generation cephalosporin with no anaerobic activity or BBB penetration.
A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination?
- A. Eliciting the cremasteric reflex is recommende
- C. The glans is assessed for redness or lesions.
- D. COM
Correct Answer: C
Rationale: The correct answer is C: The glans is assessed for redness or lesions. This is the appropriate step for a genital examination in a 2-month-old uncircumcised infant to check for any signs of infection or abnormalities. Eliciting the cremasteric reflex (choice A) is not necessary for a routine well-baby checkup and is more relevant in assessing testicular descent. Choices B and D are incomplete or irrelevant, not addressing the specific aspect of the genital examination needed in this scenario.
Which of the following anti-HIV regimen that is generally reserved for * advanced cases of AIDS or for repeated treatment failures?:
- A. Two nucleoside reverse transcriptase inhibitors (NRTIs) + one protease inhibitor (PI)
- B. Three NRTIs
- C. Two NRTIs + one non-NRTI
- D. One NRTI + one non-NRTI + one PI
Correct Answer: A
Rationale: The correct answer is A: Two nucleoside reverse transcriptase inhibitors (NRTIs) + one protease inhibitor (PI). This regimen is typically reserved for advanced cases of AIDS or repeated treatment failures due to its potent antiviral effects. NRTIs inhibit viral replication by interfering with the HIV enzyme reverse transcriptase, while PIs inhibit the enzyme protease, essential for viral maturation. Combining these two classes of drugs provides a strong barrier against HIV resistance. Other choices (B, C, D) are less effective in advanced cases as they do not provide the same level of dual inhibition necessary to combat resistant strains and advanced disease progression.