Nursing Elites

1. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Has your child received all recommended vaccinations?
• B. Has your child been feeding poorly or showing signs of constipation?
• C. Has your child been exposed to any sick individuals?
• D. Has your child been displaying signs of respiratory distress?

Correct answer: B

Rationale: The correct answer is B. Poor feeding and constipation are common early symptoms of infant botulism, which is caused by a neurotoxin that impairs muscle function. Option A is unrelated to the presentation of botulism. Option C does not directly relate to the symptoms of botulism. Option D is more indicative of respiratory issues rather than the constellation of symptoms seen in botulism.

2. A patient has been prescribed an estrogen-progestin oral contraceptive. The nurse should emphasize that the risk of thrombophlebitis is most likely in patients who:

• A. Are diabetic.
• B. Smoke cigarettes.
• C. Have a history of hypertension.
• D. Are older than 40.

Correct answer: B

Rationale: The correct answer is B: Smoke cigarettes. Smoking is a significant risk factor for thrombophlebitis, especially when combined with estrogen-progestin contraceptives. Choice A, being diabetic, does not directly increase the risk of thrombophlebitis in this context. Choice C, having a history of hypertension, is not a primary risk factor for thrombophlebitis. Choice D, being older than 40, is not the most likely factor associated with an increased risk of thrombophlebitis in patients taking estrogen-progestin oral contraceptives.

3. How does tamsulosin (Flomax) primarily benefit male patients with benign prostatic hyperplasia (BPH)?

• A. Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow.
• B. Reduction in prostate size and improvement in urinary symptoms.
• C. Increase in urine flow and relief of urinary obstruction.
• D. Improvement in erectile function.

Correct answer: A

Rationale: The correct answer is A: Tamsulosin works by relaxing the muscles in the prostate and bladder neck, which helps improve urinary flow in patients with BPH. This relaxation reduces the symptoms associated with BPH, such as urinary hesitancy, urgency, and frequency. Choice B is incorrect because tamsulosin does not directly reduce the size of the prostate gland. Choice C is incorrect as while tamsulosin does improve urine flow, its primary mechanism of action is through muscle relaxation rather than directly relieving obstruction. Choice D is incorrect as tamsulosin is not indicated for improving erectile function; its main therapeutic effect is targeted towards urinary symptoms related to BPH.

4. A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the client that the venous blood supply to the penis is controlled by:

• A. Sympathetic nerves.
• B. Parasympathetic nerves.
• C. Somatic nerves.
• D. Spinal reflexes.

Correct answer: B

Rationale: Erectile function is primarily controlled by the parasympathetic nervous system, which facilitates the dilation of blood vessels in the penis. The parasympathetic nerves are responsible for vasodilation in the penis, allowing blood to enter and creating an erection. Sympathetic nerves, on the other hand, are responsible for ejaculation by causing contraction of the muscles around the vas deferens. Somatic nerves are involved in sensation and movement, not specifically in controlling blood supply to the penis. Spinal reflexes can play a role in the erectile process, but they are not directly responsible for controlling the venous blood supply.

5. What signs and symptoms most likely prompted this patient to initially seek care?

• A. Malaise and fatigue
• B. Severe diarrhea
• C. Intermittent fever
• D. Dizziness and confusion

Correct answer: B

Rationale: The correct answer is B: Severe diarrhea. A patient who has recently returned from a trip to Nepal with a nongovernmental organization and is seeking care for amebiasis would most likely have been prompted by the symptom of severe diarrhea. Amebiasis is an infection caused by the parasite Entamoeba histolytica, commonly transmitted through contaminated food or water sources in developing countries like Nepal. The hallmark symptom of amebiasis is dysentery, which is characterized by severe diarrhea with blood or mucus in the stool. Malaise and fatigue (choice A) are nonspecific symptoms that may accompany many illnesses and are not specific to amebiasis. Intermittent fever (choice C) is not a typical presenting symptom of amebiasis, which primarily manifests with gastrointestinal symptoms. Dizziness and confusion (choice D) are also not typical symptoms associated with amebiasis.

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