Nursing Elites

1. In which of the following cases is dehydration more likely to occur?

• A. A 50-year-old woman who is a bodybuilder
• B. A 50-year-old man who is morbidly obese
• C. A 10-year-old child who is thin
• D. A 30-year-old with multiple sclerosis

Correct answer: B

Rationale: Dehydration is more likely to occur in a 50-year-old man who is morbidly obese due to the increased risk of conditions like diabetes and heart disease that can lead to fluid imbalances. Being morbidly obese can also strain the body's systems, increasing the need for water. The other choices are less likely to experience dehydration as a primary concern. While being a bodybuilder may require strict hydration practices, dehydration is more prevalent in individuals with conditions like obesity.

2. A patient who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this patient's most likely diagnosis?

• A. Active tuberculosis
• B. Latent tuberculosis
• C. Mycobacterium avium complex
• D. Human immunodeficiency virus

Correct answer: A

Rationale: The correct answer is A: Active tuberculosis. Given the patient's history of homelessness and initiation of isoniazid (INH) treatment, the most likely diagnosis is active tuberculosis. Isoniazid is a first-line medication used in the treatment of active tuberculosis. Latent tuberculosis (choice B) would not typically necessitate treatment with isoniazid alone. Mycobacterium avium complex (choice C) is not typically treated with isoniazid alone. Human immunodeficiency virus (choice D) is a risk factor for developing tuberculosis but is not the primary diagnosis in this patient scenario.

3. A woman is complaining that she feels like the room is spinning even though she is not moving. Which of the following is characteristic of benign positional vertigo?

• A. It usually occurs with a headache.
• B. Pupillary changes are common.
• C. It is usually triggered when the patient bends forward.
• D. Nystagmus continues even when the eyes fixate on an object.

Correct answer: C

Rationale: The correct answer is C: 'It is usually triggered when the patient bends forward.' Benign positional vertigo is often triggered by changes in head position, such as bending forward. Choices A, B, and D are incorrect. A is incorrect because benign positional vertigo is not typically associated with headaches. B is incorrect because pupillary changes are not a common feature of benign positional vertigo. D is incorrect because nystagmus in benign positional vertigo usually stops when the eyes fixate on an object.

4. What is a potential implication of multiple dark bands on the nails?

• A. They are considered a normal variant.
• B. They can be associated with malignant melanoma.
• C. They are indicative of a nail fungus.
• D. They are associated with aging.

Correct answer: B

Rationale: Multiple dark bands on the nails can be a concerning sign of malignant melanoma, a type of skin cancer that can affect the nails. While some nail changes are considered normal variants, dark bands should not be dismissed lightly as they can indicate a serious condition like melanoma. Nail fungus typically presents differently, causing discoloration, thickening, or distortion of the nail without distinct dark bands. Additionally, aging can lead to various nail changes, but dark bands alone are not a common feature of normal aging.

5. A patient arrives at her follow-up appointment 1 month post-hysterectomy and complains to the nurse that her scars do not seem to be healing properly. Upon inspection, the nurse notices that the scars are raised but still within the boundaries of the original incisions. The nurse tells the patient this kind of dysfunctional wound healing is called:

• A. Hypertrophic scarring
• B. Dehiscence
• C. Contracture
• D. A keloid

Correct answer: A

Rationale: Hypertrophic scarring occurs when a scar is raised but remains within the boundaries of the original wound, unlike keloids, which extend beyond the wound edges. Dehiscence refers to the separation of wound edges, while contracture involves the tightening or constriction of a scar, leading to limited mobility.

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