NCLEX Daily Practical Exercise 35

Welcome to our NCLEX Daily Ten Practice! This practice is designed to help you solidify your knowledge, improve your skills, and prepare thoroughly for the NCLEX exam. With ten questions to tackle each day, you’ll have the opportunity to review a broad range of subjects covered in the NCLEX exam.

 

1. A 32-year-old female patient presents to the outpatient clinic with complaints of red, itchy eyes with a yellowish discharge for the past three days. She mentions she recently returned from a trip abroad. The nurse, upon reviewing her medical history, notes a previous episode of conjunctivitis last year. Given the patient’s presentation and travel history, the nurse suspects a bacterial cause for the conjunctivitis. Which of the following microorganisms, based on the patient’s symptoms and history, is most likely responsible for her current condition?

Correct Answer: D

Answer Explanation:

Haemophilus influenzae biogroup aegyptius (Hae) is a causative agent of acute and often purulent conjunctivitis, more commonly known as pink eye. The other microorganisms listed are associated with different diseases and are not typically responsible for conjunctivitis.

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2. A 45-year-old female patient presents to the outpatient clinic with complaints of intermittent joint pain, fatigue, and cognitive disturbances. She recalls having a rash resembling a “bull’s-eye” a few weeks ago after a hiking trip in a tick-endemic area. The nurse, upon reviewing her medical history, notes a recent diagnosis of Lyme disease. Given the patient’s presentation and history, which of the following microorganisms is most likely responsible for her condition?

Correct Answer: A

Answer Explanation:

Lyme disease is the most common vector-borne disease in the United States. Lyme disease is caused by the bacterium Borrelia burgdorferi and rarely, Borrelia mayonii.

Option B: Group A Streptococcus (group A strep, Streptococcus pyogenes) can cause both noninvasive and invasive disease, as well as nonsuppurative sequelae.
Option C: Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis.
Option D: Enterococcus faecalis and Enterococcus faecium are the most prevalent species cultured from humans, accounting for more than 90% of clinical isolates. Infections commonly caused by enterococci include urinary tract infection (UTIs), endocarditis, bacteremia, catheter-related infections, wound infections, and intra-abdominal and pelvic infections.

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3. A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and falls over the last two (2) weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed?

Correct Answer: D

Answer Explanation:

A CT scan would be performed for further investigation of the hemiparesis. Noncontrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.

Option A: A complete blood count (CBC) and a basic chemistry panel can be useful baseline studies. A CBC serves as a baseline study and may reveal a cause for the stroke (eg, polycythemia, thrombocytosis, thrombocytopenia, leukemia), identify evidence of concurrent illness (eg, anemia), or issues that may affect reperfusion strategies (thrombocytopenia).
Option B: Electrocardiogram may serve as baseline data upon entry into the ED. An electrocardiogram (ECG or EKG) records the electrical signal from the heart to check for different heart conditions. Electrodes are placed on the chest to record the heart’s electrical signals, which cause the heart to beat. The signals are shown as waves on an attached computer monitor or printer.
Option C: Testing can often be limited to blood glucose, plus coagulation studies if the patient is on warfarin, heparin, or one of the newer antithrombotic agents (eg, dabigatran, rivaroxaban), not including thyroid studies.

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4. An 85-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?

Correct Answer: C

Answer Explanation:

Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function. Thyroid function tests are designed to distinguish hyperthyroidism and hypothyroidism from the euthyroid state. To accomplish this task, direct measurements of the serum concentration of the two thyroid hormones—triiodothyronine (T3) and tetraiodothyronine (T4)—more commonly known as thyroxine, are extensively employed.

Option A: The complete blood count and metabolic profile may show abnormalities in patients with hypothyroidism. Thyroid dysfunction induces different effects on blood cells such as anemia, erythrocytosis, leukopenia, thrombocytopenia, and in rare cases causes’ pancytopenia.
Option B: Signs of hypothyroidism on ECG include sinus bradycardia, T-wave inversions (TWIs), QTc prolongation, and ventricular arrhythmias. Hypothyroidism can affect the cardiovascular system physiology and structure. These changes are often reflected on ECG.
Option D: Ultrasonography of the neck and thyroid can be used to detect nodules and infiltrative disease. High-resolution ultrasonography (USG) is the most sensitive imaging modality available for examination of the thyroid gland and associated abnormalities. Ultrasound scanning is non-invasive, widely available, less expensive, and does not use any ionizing radiation. Further, real-time ultrasound imaging helps to guide diagnostic and therapeutic interventional procedures in cases of thyroid disease.

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5. A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?

Correct Answer: C

Answer Explanation:

Blood cultures would be performed to investigate the fever and rash symptoms. A blood culture is a test that checks for foreign invaders like bacteria, yeast, and other microorganisms in the blood. Having these pathogens in the bloodstream can be a sign of a blood infection, a condition known as bacteremia. A positive blood culture means that there are bacteria in the blood.

Option A: Blood sugar check is necessary for clients who are suspected of having an increase in blood sugar and whose symptoms include excessive thirst and hunger, and excessive sweating.
Option B: CT scan is unnecessary at the time for a client with fever and rash. A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around the body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside the body. CT scan images provide more detailed information than plain X-rays do.
Option D: An arterial blood gas (ABG) test measures oxygen and carbon dioxide levels in the blood. It also measures the body’s acid-base (pH) level, which is usually in balance when healthy.

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