Nursing Elites

1. A 5-year-old male presents with low-set ears, a fish-shaped mouth, and involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels. Which of the following diagnoses is most likely?

• A. B cell deficiency
• B. T cell deficiency
• C. Combined immunodeficiency
• D. Complement deficiency

Correct answer: B

Rationale: The correct answer is B: T cell deficiency. The symptoms described in the case, including low-set ears, a fish-shaped mouth, involuntary rapid muscular contraction, and decreased calcium levels, are indicative of DiGeorge syndrome. This syndrome is characterized by T cell deficiency due to thymic hypoplasia. B cell deficiency (Choice A), combined immunodeficiency (Choice C), and complement deficiency (Choice D) do not align with the clinical presentation and laboratory findings provided in the case. Therefore, T cell deficiency is the most likely diagnosis in this scenario.

2. What tool is used to determine a client’s level of consciousness?

• A. Magnetic resonance imaging (MRI)
• B. Glasgow Coma Scale (GCS)
• C. Central perfusion pressure (CPP)
• D. Intracranial pressure (ICP) monitoring

Correct answer: B

Rationale: The correct answer is B: Glasgow Coma Scale (GCS). The Glasgow Coma Scale is specifically designed to assess a client's level of consciousness by evaluating verbal, motor, and eye-opening responses. Choice A, Magnetic Resonance Imaging (MRI), is a diagnostic imaging tool that provides detailed images of the body's organs and tissues but is not used to assess consciousness levels. Choice C, Central Perfusion Pressure (CPP), and Choice D, Intracranial Pressure (ICP) monitoring, are related to hemodynamic monitoring and intracranial pressure management, not direct assessment of consciousness.

3. In which patient would the manifestation of a headache be a sign of a serious underlying disorder?

• A. A 55-year-old man with new onset of headaches that are worse at night and reported mood swings according to his family
• B. A 30-year-old woman with a unilateral throbbing headache with photophobia and nausea
• C. A 60-year-old man with his head feeling full and throbbing and muscle aching around his neck and shoulders
• D. A 40-year-old woman who experiences food cravings, gets irritable, and then develops a pulsatile-like headache on the right side of her head

Correct answer: A

Rationale: The correct answer is A. New onset headaches in older adults, especially if worse at night, may indicate a serious condition like a brain tumor. Choice B describes symptoms commonly seen in migraines. Choice C describes tension-type headaches. Choice D describes symptoms of a menstrual migraine which is not typically associated with a serious underlying disorder.

4. In which disorder does a Staphylococcus aureus organism produce a toxin leading to exfoliation and large blister formation?

• A. Herpes simplex I virus
• B. Herpes simplex II virus
• C. Necrotizing fasciitis
• D. Cellulitis

Correct answer: B

Rationale: The correct answer is 'Herpes simplex I virus.' This disorder is known as Staphylococcal scalded skin syndrome (SSSS), where a Staphylococcus aureus organism produces an exfoliative toxin leading to skin exfoliation and large blister formation. Choices B, C, and D are incorrect. Herpes simplex viruses (I and II) cause different types of skin lesions and do not lead to exfoliation and blister formation. Necrotizing fasciitis is a severe soft tissue infection, while cellulitis is a bacterial skin infection that does not typically involve exfoliation and blister formation like in SSSS.

5. After ingestion of cysts, how long does it take for the symptoms of giardiasis to develop?

• A. 12 to 24 hours
• B. 3 to 5 days
• C. 1 to 2 weeks
• D. 2 to 3 months

Correct answer: B

Rationale: Giardiasis symptoms typically develop 3 to 5 days after ingestion of the cysts. This timeframe aligns with the incubation period of the Giardia parasite. Choice A (12 to 24 hours) is too short for giardiasis to manifest. Choice C (1 to 2 weeks) and choice D (2 to 3 months) represent durations that are not consistent with the usual onset of symptoms in giardiasis.

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