Nursing Elites

1. Which of the following is a factor that leads to increased risk for dehydration in the elderly?

• A. More insensible losses
• B. Increase in muscle mass
• C. Decline in kidney function
• D. Decrease in fat

Correct answer: C

Rationale: The correct answer is C: Decline in kidney function. As people age, their kidneys may not work as effectively in conserving water and concentrating urine, leading to a higher risk of dehydration. Choice A is incorrect because more insensible losses do not directly relate to an increased risk of dehydration in the elderly. Choice B, an increase in muscle mass, is not a factor that leads to dehydration. Choice D, a decrease in fat, is also not a direct factor contributing to dehydration in the elderly.

2. A 30-year-old male has been brought to the emergency department by his wife because of a severe headache, nausea, vomiting, and fever. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals a high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs). Which organism is the most likely cause of these findings?

• A. Streptococcus pneumoniae
• B. Neisseria meningitidis
• C. Escherichia coli
• D. Listeria monocytogenes

Correct answer: A

Rationale: The cerebrospinal fluid (CSF) analysis findings of high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs) are classic for bacterial meningitis. Among the choices, Streptococcus pneumoniae is the most likely cause in this case. Streptococcus pneumoniae is a common cause of bacterial meningitis in adults, especially presenting with symptoms such as severe headache, nausea, vomiting, and fever. Neisseria meningitidis is another common cause of bacterial meningitis but is more frequently associated with a different CSF profile. Escherichia coli is a common cause of neonatal meningitis, not typically seen in a 30-year-old male. Listeria monocytogenes is more commonly associated with meningitis in immunocompromised individuals and neonates, and typically presents differently in CSF analysis.

3. A 70-year-old patient is seen in the family practice clinic. Which of the following vaccines should be administered to prevent shingles?

• A. Zoster vaccine
• B. Haemophilus influenzae Type b (Hib) vaccine
• C. Human papillomavirus (HPV) vaccine
• D. Pneumococcal polyvalent vaccine

Correct answer: A

Rationale: The correct answer is A: Zoster vaccine. The Zoster vaccine is recommended for the prevention of shingles in individuals aged 50 years and older. Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. The vaccine helps reduce the risk of developing shingles and decreases the severity and duration of the illness if it occurs. Choices B, C, and D are incorrect: Haemophilus influenzae Type b (Hib) vaccine is used to prevent infections caused by Haemophilus influenzae type b, Human papillomavirus (HPV) vaccine is used to prevent HPV infections that can lead to cervical cancer and other cancers, and Pneumococcal polyvalent vaccine is used to protect against infections caused by the bacterium Streptococcus pneumoniae.

4. Which of the following characteristics is common in both malignant and benign tumors?

• A. Uncontrolled cell growth
• B. Rapid growth
• C. Metastasis
• D. Invasion of surrounding tissue

Correct answer: A

Rationale: The correct answer is A: Uncontrolled cell growth. This characteristic is common to both malignant and benign tumors. Benign tumors are non-cancerous growths that do not invade nearby tissue or spread to other parts of the body. Therefore, choices B, C, and D are incorrect. Rapid growth, metastasis, and invasion of surrounding tissue are characteristics typically associated with malignant tumors.

5. A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?

• A. Decreased interest in activities that she once enjoyed
• B. Fear of being alone at night
• C. Increased complaints of physical ailments
• D. Problems with preparing a meal or balancing her checkbook

Correct answer: D

Rationale: The correct answer is D. Problems with tasks like meal preparation and balancing a checkbook can indicate cognitive impairment, as these activities involve cognitive functions such as memory, attention, and executive function. Choices A, B, and C are less indicative of cognitive impairment. Decreased interest in activities and increased complaints of physical ailments may be related to other factors like depression, while fear of being alone at night could be due to anxiety or other psychological issues.

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