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Which patient is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)?
- A. A patient who has experienced a spinal cord injury and reports severe, burning pain in his legs.
- B. A patient who reports severe pain in her hand following a surgery for carpal tunnel syndrome.
- C. A patient who develops pain in his foot following a fracture and immobilization with a cast.
- D. A patient who experiences chronic pain and swelling in his arm following a brachial plexus injury.
Correct Answer: D
Rationale: Complex regional pain syndrome II (CRPS II) typically occurs after an injury to a peripheral nerve. In this case, a brachial plexus injury involves damage to the nerves that control muscles in the arm and hand, leading to chronic pain and swelling. Choices A, B, and C describe pain related to other conditions such as spinal cord injury, carpal tunnel surgery, and fracture immobilization, which are not typically associated with CRPS II.
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What aspect of hormonal contraceptives places a woman at the greatest risk for the development of blood clots?
- A. Hormonal contraceptives increase serum triglyceride and cholesterol levels.
- B. Hormonal contraceptives increase platelet levels.
- C. Hormonal contraceptives increase blood levels of clotting factors.
- D. Hormonal contraceptives cause injury to blood vessel linings.
Correct Answer: C
Rationale: The correct answer is C. Hormonal contraceptives increase blood levels of clotting factors, particularly factors II, VII, IX, and X. This elevation in clotting factors can predispose individuals to thromboembolic events, including blood clots. Choices A, B, and D are incorrect because hormonal contraceptives do not have a significant effect on serum triglycerides and cholesterol, platelet levels, or causing direct injury to blood vessel linings as the primary mechanism for clot formation.
During an assessment of a male client suspected of having a disorder of motor function, which finding would suggest a possible upper motor neuron (UMN) lesion?
- A. Hypotonia
- B. Hyperreflexia
- C. Muscle atrophy
- D. Fasciculations
Correct Answer: B
Rationale: Hyperreflexia, or exaggerated reflexes, is a common sign of an upper motor neuron (UMN) lesion. An UMN lesion indicates damage to the central nervous system pathways that control movement. Hypotonia (choice A) refers to reduced muscle tone, which is more indicative of lower motor neuron lesions. Muscle atrophy (choice C) suggests long-standing denervation or disuse of muscles. Fasciculations (choice D) are involuntary muscle contractions that can be seen in lower motor neuron lesions, like in amyotrophic lateral sclerosis (ALS), rather than UMN lesions.
A 20-year-old college student has presented to the campus medical clinic seeking to begin oral contraceptive therapy. The nurse has recognized the need for adequate health education related to the patient's request. The nurse should emphasize the fact that successful prevention of pregnancy depends primarily on the patient's
- A. current health status.
- B. vigilant adherence to the drug regimen.
- C. knowledge of sexual health.
- D. risk factors for adverse effects.
Correct Answer: B
Rationale: The correct answer is B: 'vigilant adherence to the drug regimen.' When initiating oral contraceptive therapy, the success of preventing pregnancy relies heavily on the patient's commitment to following the prescribed regimen consistently. Compliance with taking the oral contraceptives as directed is crucial for their effectiveness. Choice A, 'current health status,' is not the primary factor for successful prevention of pregnancy with oral contraceptives. Choice C, 'knowledge of sexual health,' while important, is not the primary determinant of contraceptive efficacy. Choice D, 'risk factors for adverse effects,' though relevant for monitoring and managing side effects, is not the primary focus for ensuring contraceptive success.
Which immunoglobulin is the first to appear in response to a new antigen?
- A. IgA
- B. IgG
- C. IgE
- D. IgM
Correct Answer: D
Rationale: The correct answer is IgM. IgM is the first immunoglobulin to appear in response to a new antigen. It is produced initially during the primary immune response. IgA is mainly found in mucosal areas and secretions. IgG is produced in a secondary immune response and is the most abundant immunoglobulin in the bloodstream. IgE is involved in allergic reactions and parasitic infections, not the initial response to a new antigen.
A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's questions is least likely to yield data that will confirm or rule out migraines as the cause of his problem?
- A. Does your son have a family history of migraines?
- B. When your son has a headache, does he ever have nausea and vomiting as well?
- C. Does your son have any food allergies that have been identified?
- D. Is your son generally pain-free during the intervals between headaches?
Correct Answer: C
Rationale: The correct answer is C. In assessing a child for migraines, asking about food allergies is least likely to yield data that will confirm or rule out migraines as the cause of his headaches. Food allergies are unrelated to the typical symptoms and triggers of migraines, such as family history, associated symptoms like nausea and vomiting, and pain-free intervals between headaches. Therefore, in this scenario, focusing on food allergies is less relevant for identifying migraines as the cause of the boy's headaches.